Basics of 97530 CPT code
The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity. Below is the description of 97530 CPT code.
97530 -“Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes”
A qualified health care provider uses dynamic therapeutic activities designed to achieve improved functional performance (e.g., lifting, pulling, bending). This code requires direct contact by a qualified health care provider with the patient and is billed in 15-minute units.
CPT 97530 consists of all therapeutic activities that cover a wide range of rehabilitation exercises. It includes methods which involve whole body movements and overhead activities to progressively improve performance.
Documentation under CPT code 97530 typically incorporates two or more targeted areas which could include balance, strength, range of motion, and/or a functional activity. Documentation should include the targeted areas, the specific parameters of the activity, the repetitions, assistance levels required, the skilled interventions provided by the therapist to improve or address the functional treatment area.
Choosing between CPT code 97530 or code 97110 depends on the intent of the task. For example, squatting can be used for strengthening and billed under therapeutic exercise; however, if the patient is squatting for item retrieval from floor level, then you can code as therapeutic activity.
Coding example for 97530 cpt code
A 26-year-old male presents with a complete spinal cord lesion resulting in paraplegia. The patient presents with paralysis of the lower extremities and bilateral upper-extremity (UE) weakness secondary to prolonged immobility, as well as decreased core strength and postural control.
Therapeutic exercises focused on restoring and increasing UE strength for compensatory strategies would be reported with CPT code 97110, Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility, with modifier 97 appended because the procedure is rehabilitative in nature.
Therapeutic activities focused on skill acquisition for wheelchair management and mobility, including transferring to and from the wheelchair, would be reported with code 97530, Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes, with modifier 96 appended because these services are habilitative in nature.