97130 CPT Cognitive Rehab Reimbursement

CPT code 97130 represents additional 15‑minute increments of one–on–one cognitive rehabilitation or therapeutic interventions designed to improve thinking, memory, reasoning, problem solving, and task planning and execution. Nationally, this code is important for documenting and reimbursing focused cognitive therapy delivered by qualified clinicians in outpatient and rehabilitation settings, where incremental time-based billing affects revenue capture and clinical documentation expectations. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 97130 covers, typical sites of service, common billing and coding considerations, and the clinical context for use. The publication summarizes national benchmark elements such as typical use cases and service lines, highlights payer coverage patterns and coding practice implications, and outlines areas where policy updates or payer-specific instructions commonly affect claim adjudication. Data not available in the input is noted where applicable. This resource is intended to clarify the code’s clinical scope and billing role for clinicians, billers, and policy analysts working with time‑based cognitive therapy services.

Billing Code Overview

CPT code 97130 describes one–on–one therapeutic interventions focused on cognitive function. The provider works directly with the patient to improve thinking, memory, reasoning, problem solving, and the ability to plan, organize, and carry out tasks. This code represents each additional 15 minutes of direct, individualized cognitive rehabilitation or remediation provided by the practitioner.

Service type: Cognitive rehabilitation / therapeutic interventions (one–on–one, per 15 minutes)

Typical site of service: Outpatient clinics, rehabilitation centers, skilled therapy settings, and other ambulatory care locations where individualized therapeutic interventions are delivered

Clinical Context

A typical patient is a 72-year-old male with progressive cognitive decline following a mild ischemic stroke and recent difficulties with memory, executive function, and task planning. He is referred by his primary care physician or neurologist for outpatient cognitive rehabilitation. The therapeutic session is delivered one–on–one by a licensed occupational therapist or speech-language pathologist trained in cognitive interventions. The session includes standardized cognitive assessments, task-specific training (memory strategies, problem-solving exercises, sequencing tasks), and functional carryover practice aimed at improving activities of daily living (medication management, sequencing household tasks). Each billed unit of 97130 represents one additional 15-minute block of direct patient–provider therapeutic contact focused on cognitive retraining. Typical sites of service include outpatient rehabilitation clinics, hospital outpatient departments, skilled nursing facilities, and home health visits when the therapist provides direct, face-to-face cognitive therapy. Documentation includes start and stop times, specific interventions provided, patient response and progress, measurable goals, and coordination notes with the referring clinician.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When `97130` is performed separately from another service that might be bundled (e.g., a separate therapeutic procedure) and documentation supports distinct service.

Taxonomy Code	Specialty	Notes
`103T00000X`	Occupational Therapist	Frequently provides cognitive rehabilitation targeting daily function and executive skills.
`234Z00000X`	Speech-Language Pathologist	Provides cognitive-communication therapy for memory, attention, problem-solving, and language-based deficits.
`2084P0800X`	Physical Medicine & Rehabilitation (Physiatry)	Often oversees rehabilitation programs and coordinates cognitive therapy as part of multidisciplinary care.
`207RC0000X`	Neurology	Referral source and diagnostic oversight for patients with stroke, TBI, or neurodegenerative conditions requiring cognitive therapy.
`208D00000X`	Psychiatry	May co-manage cognitive impairment related to mood, neurocognitive disorders, or medication effects.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G31.84`	Mild cognitive impairment, so stated	Common indication for cognitive therapy targeting memory and executive function to preserve daily functioning.
`F02.80`	Dementia in other diseases classified elsewhere without behavioral disturbance	Cognitive rehabilitation used to maximize independence and slow functional decline where appropriate.
`F03.90`	Unspecified dementia, without behavioral disturbance	Supports interventions to address memory, problem solving, and task sequencing in dementia care plans.
`I63.9`	Cerebral infarction, unspecified	Post-stroke cognitive deficits often require one-on-one cognitive training captured with `97130`.
`S06.2X9A`	Diffuse traumatic brain injury with loss of consciousness of unspecified duration, initial encounter	Cognitive remediation after TBI commonly uses `97130` for focused, timed therapeutic contact.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97110`	Therapeutic exercises to develop strength, endurance, range of motion and flexibility (each 15 minutes)	Often provided in the same rehabilitation plan when physical impairments accompany cognitive deficits; billed separately when distinct therapeutic focus.
`97112`	Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception (each 15 minutes)	Used when motor relearning is required in parallel with cognitive retraining, such as after stroke.
`97530`	Therapeutic activities, direct (one-on-one) patient contact using dynamic activities to improve functional performance (each 15 minutes)	May be used for task-specific functional practice that overlaps with cognitive strategies; choose code based on primary therapeutic focus.
`97535`	Self-care/home management training (e.g., activities of daily living and compensatory training) (each 15 minutes)	Frequently complements `97130` when training in medication management, scheduling, or household task sequencing is required.
`92523`	Evaluation of speech fluency and/or language comprehension with or without cognitive-communication evaluation	Performed by speech-language pathologist as part of assessment when cognitive–communication deficits are present; precedes individualized `97130` interventions.

OpenPayer

Summary & Overview

CPT 97130: Cognitive Rehabilitation, Per 15 Minutes