2024 Worksheet on Caregiver Codes
Please note: CMS has approved these codes for OT PT and ST effective 1/1/2024.
Although CMS is the gold standard for commercial carriers, and many follow their
lead in approved CPT codes, do not assume that all carriers will automatically
approve and pay for the codes. Additionally, as with all codes, these are not adult
or pediatric driven.
These are all for trainings done without the patient being present.
97550 timed code first 30 minutes Individual sessions -Face to face not telehealth
eligible. Caregiver training in strategies and techniques to facilitate the patient’s
functional performance in the home or community (ie. activities of daily living [ADLs],
instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding,
problem solving, safety practices) (without the patient present), face-to-face; initial 30
minutes. Identification and implementation of compensatory strategies for proper sequencing,
following directions, and safe activity completion; graded interventions focusing on
motor, process, communication, and other skills that affect functional activity
performance; problem-solving approaches to adapt to unusual tasks; environmental
adaptation training; use of individualized visual or verbal cueing, memory devices (ie.
picture lists) sequenced directions or other approaches to enable completion of
activities; or training in use of equipment or assistive devices for self-care/home
management.
97751 add on code with 97550 – Timed code for each subsequent 15 minutes.
Caregiver training in strategies and techniques to facilitate the patient’s functional
performance in the home or community (ie. activities of daily living [ADLs], instrumental
ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving,
safety practices) (without the patient present), face-to-face; each additional 15 minutes.
(List separately in addition to code for primary service)
(Use 97551 in conjunction with 97550) Identification and implementation of
compensatory strategies for proper sequencing, following directions, and safe activity
completion; graded interventions focusing on motor, process, communication, and other
skills that affect functional activity performance; problem-solving approaches to adapt to
unusual tasks; environmental adaptation training; Individual sessions Face to face not
telehealth eligible use of individualized visual or verbal cueing, memory devices (ie. picture lists) sequenced directions or other approaches to enable completion of
activities; or training in use of equipment or assistive devices for self-care/home
management.
For groups: 97752 Untimed code up to 60 minutes for group training for
caregivers of multiple patients. Face to face not telehealth eligible. Group caregiver
training in strategies and techniques to facilitate the patient’s functional performance in
the home or community (ie. activities of daily living [ADLs], instrumental ADLs [IADLs],
transfers, mobility, communication, swallowing, feeding, problem solving, safety
practices) (without the patient present), face-to-face with multiple sets of caregivers.
Identification and implementation of compensatory strategies for proper sequencing,
following directions, and safe activity completion; graded interventions focusing on
motor, process, communication, and other skills that affect functional activity
performance; problem-solving approaches to adapt to unusual tasks; environmental
adaptation training; use of individualized visual or verbal cueing, memory devices (ie.
picture lists) sequenced directions or other approaches to enable completion of
activities; or training in use of equipment or assistive devices for self-care/home
management. The provider facilities group problem solving to enhance generalizability
of concepts across participants. The provider guides and assesses return
demonstration by caregivers of activity or task performance required to ensure safety
and efficient completion. This is appropriate to bill when the patients have similar
conditions and or similar therapy goals and needs.
Additional Considerations when Using and Documenting the codes:
(1) Know what is considered a “caregiver” as it relates to these codes. CMS considers 2
definitions:
“an adult family member or other individual who has a significant relationship with, and
who provides a broad range of assistance to, an individual with a chronic or other health
condition, disability, or functional limitation” or
“a family member, friend, or neighbor who provides unpaid assistance to a person with a
chronic illness or disabling condition.”
(2) When reporting CPT codes 97550, 97551, and 97552, you must do so as part of the
plan of care.
(3) Patient consent for caregiver training services (CTS), must be specific to the
services and documented in the record. You must also document in the record the need
for each occurrence of CTS.
(4) This procedure is not and should not be the only means of caregiver training for any
patient. The standard for provision of caregiver training is to do so with the patient
present. Reporting these new codes should occur only when needed, and
documentation must support the reason for the deviation from the standard of doing
caretaker trainer in the presence of the client.
(5) It is good to be able to show when a more intense interaction with the caregiver
without the patient in attendance is necessary to ensure adequate skill acquisition by
the caregiver.
(6) Sometimes Therapy – CMS has designated the caregiver training codes as
‘‘sometimes therapy,” which means that, when appropriate, the services can be billed
outside a therapy plan of care by a physician and certain other nonphysician providers.
As “sometimes therapy” codes, the caregiver training codes are not subject to multiple
procedure payment reduction. It is hard at this point to know what “when appropriate”
means so the prudent thing to do is to include it in a plan of care.
This worksheet is for informational purposes only and does not replace individual
consultations as to the use of these codes in treatment and documentation.