Understanding the 97129 CPT Code for Occupational Therapy
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Occupational therapists use many CPT codes when evaluating and treating their clients, such as the 97129 CPT code.
In this article, we’ll go into detail about how to use the 97129 CPT code, along with examples of cognitive assessments and cognitive strategies you can use with clients.
Current Procedural Terminology (CPT) codes are five-digit codes developed by the American Medical Association (AMA). These codes are universal medical codes for procedures and services that are used for medical billing and insurance reimbursement.
As occupational therapists (OTs), CPT codes are a part of service delivery. It’s important to know the various CPT codes for occupational therapy to accurately document for skilled intervention. CPT codes are also essential to receive proper reimbursement for services rendered when billing private insurance, Medicare, or Medicaid.
What is the 97129 CPT code for?
The 97129 CPT code focuses on cognitive therapy for adults.
Introduced in 2020, the 97129 CPT code is a time-based code described as:
“Therapeutic interventions that focus on cognitive function (e.g. attention, memory, reasoning, executive function, problem-solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes.”
There are specific codes for different disciplines, such as rehabilitative or speech and language services.
Occasionally, more than one discipline can use the same code. For example, two disciplines can use the 97129 CPT code: occupational therapy and speech and language therapy.
97129 CPT code description for OTs vs. SLPs
The 97129 CPT code can be used by both occupational therapists (OTs) and speech and language therapists (SLPs). This code can only be billed once a day.
Getting reimbursement for the 97129 CPT code for occupational therapy can depend on your client's diagnosis.
Cognitive services are not covered by insurance for every diagnosis, so it’s important to check with your client’s private insurance, Medicare, or Medicaid before billing.
Learning about and understanding medical coding and billing for reimbursement is complicated. It can become even more complicated when services overlap with other disciplines, like speech therapy.
Medicare Part B has allotted yearly amounts for services. Hence, if your client is receiving services from more than one discipline, it is critical to monitor CPT codes and allotted amounts.
CPT code 97129 falls under the 97000 series of CPT codes, which is usually reserved for physical rehabilitation (occupational therapy and physical therapy). However, SLPs also use codes 97129 and 97130.
An occupational therapist may give a cognitive assessment as part of their evaluation. If they determine that cognitive intervention is necessary, they would utilize the 97129 CPT code.
A speech-language pathologist may give a cognitive communication assessment, and their plan of care may involve cognitive speech therapy, including cognitive communication strategies.
This is why it’s important to speak and collaborate with clinicians in other disciplines to ensure billing for these services is done correctly by each person on your client or patient’s care team.
Using the 8-minute rule
The Centers for Medicare and Medicaid Services (CMS) 8-minute rule applies to this code. The 8-minute rule states that you, as the practitioner, must have spent at least eight minutes of direct treatment to bill for one unit (15 minutes) of time.
CPT code 97130 (a time-based add-on code) is frequently used in combination with CPT code 97129.
97130 is used for an additional 15 minutes of time, since 97129 can only be used once a day.
Cognitive assessments for OTs
Cognitive assessments can be both standardized and informal, and they can also include caregiver interviews.
These assessments often overlap between occupational therapy and speech and language therapy, as they look at the areas of pragmatics, problem-solving, and executive function skills.
Collaboration with speech therapy, when indicated, can be a great way to support client outcomes. Cognitive speech therapy for adults may be done in conjunction with cognitive occupational therapy.
Talking to and collaborating with other clinicians, including SLPs, can be important for various reasons.
Using the correct CPT code can contribute toward ensuring you are keeping lines of communication open and receiving proper reimbursement for your clients.
Examples of cognitive assessments include:
- Executive Function Performance Test (EFPT)
- Clock Drawing Test
- Mini-Mental State Examination (MMSE)
- The Saint Louis University Mental Status (SLUMS) Examination
There are many cognitive assessments, both formal and informal, that can be used for clients with cognitive impairment. The assessment you use may depend on the particular assessment your facility promotes.
If you are a private practice practitioner, it’s important to research the available assessments and consider assessments that support the 97129 CPT code for occupational therapy.
Cognitive strategies used by occupational therapists
There are many strategies occupational therapists can use to help support cognitive skills with their clients.
Some examples of cognitive strategies include:
- Breaking down activities into simpler pieces.
- Using visual timers to keep track of time.
- Using checklists for activities.
- Writing down steps for activity completion.
- Setting reminders on a client’s phone or other device.
- Using a calendar to keep activities organized.
- Training of specific skills, such as memory or attention.
- Creating a daily schedule.
- Training in activities of daily living (ADLs).
- Stress reduction.
- Client and caregiver education and training.
- Safety training or education for the client and/or caregiver.
Occupational therapists play an important role in cognitive assessments and helping clients develop skills. OTs can also play a vital role in collaboration with speech therapy for adults with cognitive difficulties. This can include cognitive communication assessments and cognitive communication strategies.
The 97129 CPT code, in conjunction with code 97130 for occupational therapy, is commonly used to seek reimbursement for cognitive services.
Becoming familiar with CPT codes is important to save you time when seeking reimbursement. In particular, the 97129 CPT code for occupational therapy can require extra attention since it can also be used by speech and language professionals for their cognitive assessments and treatment.
As always, checking with a client’s insurance and understanding the guidelines and policies around all CPT codes is essential for correct billing and insurance reimbursement.
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