Outpatient Facility Coding Alert

Question: Do you have any information on these types of therapies (97530-97532-97533)? Is there a decent reimbursement for them, and do you have any advice regarding these therapies? 

Texas Subscriber 

Answer: CPT® codes 97530-97533 are used by physical therapists during rehabilitation of neuro-psychiatric patients to enhance sensory processing and promote adaptive responses to environmental demands. The code descriptors for these three codes are: 

• 97530 – Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

• 97532 – Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes

• 97533 – Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environment demands, direct (one-on-one) patient contact, each 15 minutes

Usually reimbursement of codes 97530-97533 is fairly similar to 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility). However, ideally, these codes should only be used if the above-mentioned rehab goals need to be achieved. 

Note: If you use these codes for normal therapeutic exercises, you are actually “upcoding,” a practice that could definitely attract the Office of Inspector General (OIG)’s attention.

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