Summary & Overview
CPT 97150: Group Therapeutic Procedures in Physical Medicine and Rehabilitation
CPT code 97150 represents group therapeutic procedures performed by physical medicine and rehabilitation professionals for two or more individuals. This code is widely used in outpatient therapy settings, such as physical therapy clinics, to deliver rehabilitation services in a group format. The procedure is essential for addressing a variety of musculoskeletal and functional impairments, including conditions like low back pain, knee pain, difficulty walking, and muscle weakness.
Major national payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a comprehensive overview of payer coverage, policy updates, and clinical benchmarks relevant to CPT 97150. Readers will gain insight into the clinical context of group therapeutic procedures, common billing modifiers such as 59 and 76, and associated provider taxonomies. Additionally, the report highlights related CPT codes and typical ICD-10 diagnoses encountered in group therapy settings.
This summary serves as a resource for understanding the national landscape of group therapeutic procedure billing, payer policies, and clinical applications. It is intended for healthcare administrators, billing professionals, and clinical leaders seeking clarity on coding, coverage, and operational considerations for CPT 97150.
CPT Code Overview
CPT 97150 is defined as Therapeutic procedure(s), group (2 or more individuals). This code is used in the context of Physical Medicine and Rehabilitation Therapeutic Procedures, specifically when therapy is provided to multiple patients simultaneously. The typical site of service for CPT 97150 is an outpatient therapy setting, such as a physical therapy outpatient clinic. This group therapy approach is designed to facilitate rehabilitation and therapeutic interventions in a collaborative environment, supporting patients with a range of musculoskeletal and functional conditions.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves a group of patients attending an outpatient physical therapy clinic for rehabilitation. Each patient presents with musculoskeletal or mobility issues, such as low back pain, knee pain, difficulty walking, or generalized muscle weakness. The physical therapist leads a group session, providing therapeutic procedures tailored to the needs of two or more individuals. The session focuses on improving mobility, strength, and functional abilities through guided exercises and activities. Documentation includes the number of participants, the therapeutic interventions performed, and the clinical rationale for group therapy.
Coding Specifications
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Modifiers:
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Modifier
59: Distinct Procedural Service. Used when group therapy (97150) is performed separately from other procedures on the same day, indicating it is a distinct service. -
Modifier
76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Used when group therapy (97150) is repeated for the same patient by the same provider on the same day.
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Provider Taxonomies: