Medical Billing Codes

Reimbursement for Cognitive Rehabilitation and Remediation Therapy is generally well accepted by most insurance companies.

Cognitive Rehabilitation Codes

Since 2020, Medicare has implemented two time-based cognitive-related CPT codes, 97129 and 97130. These codes are to be used incongruently for any therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity. Insurance coverage does vary according to the insurance company and state, but all major carriers now cover Cognitive Rehabilitation. A treatment plan is required and progress must be documented. In addition, the patient needs to be qualified to show that he or she can possibly benefit from this form of treatment.

How can these codes be used for both cognitive rehabilitation and cognitive remediation?

Both rehabilitation and remediation focus on improving the cognitive functions of an individual. The main difference between the two is not in the treatment but in the cause of the cognitive deficits and the desired treatment outcomes. From an insurance standpoint, since the treatments are identical, the insurance coding is the same.

CPT Code

Description

CPT Code & Descriptions

97129

Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem-solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes (can only be used once per day).

97130

Each additional 15 minutes after 97129 (list separately, in addition to code for primary produces)

For a printed version of this chart, please click here.

Writing Notes

When billing 97129/97130, there is no length or note a minimum of the services you are providing; However, we recommend that you fulfill the basic requirements to track the patient’s treatment plan properly.

Sample Note:

97129: Therapist instructed patient to provide solutions to common ADL problems which would impede immediate safety to increase safe completion of ADLs. Patient able to provide solutions with 70% accuracy. SLP instructed patient to complete thought organization tasks to promote word retrieval/ recall/ clarity of thought with patient able to return demonstrate generation of 10 items within a given category with maximum instruction approximately 55% accuracy.
97130: Therapist trained patient to verbally sequence 5 step ADLs to increase safe and efficient ADL completion with mod to max instruction/ demonstration and 60% accuracy. Therapist instructed patient to recall 3 unrelated words to improve short term recall with max instruction (phonemic indicators, definitions, lead in sentences), review x 2 and 30 min time lapse with 40% accuracy.

What if I want to include a full description of the intervention and activities? How do I label it?

You have two options to choose from.

1. 1. 1. Under the initial code of 97129, you can include a full description of the skilled interventions and activities provided during the treatment session. Then under 97130, you can write minimally.
    2. You can break apart which specific activities occurred during the first 15 minutes under code 97129 and the remaining treatment activities under the subsequential 91730.

Billing Units

How do I calculate the number of total units?

The base code (97129) and add-on code structure (97130) do not change the number of minutes required to fulfill units. Just like other time-based unit codes, to be eligible to bill the first unit (97129), you must complete at least 8 minutes of face-to-face therapy. To bill for additional units (97130s), you must complete a full 15 minutes of therapy (billed under 97129) and then at least an additional 8 minutes to qualify to bill under code 97130. To bill for longer units, you must meet the following requirements:

1. 1. 1. Face-to-face for the entire duration of treatment.
    2. You must be with the patient for at least 37 minutes
    3. You must exceed the halfway point of time for the next unit (see below)

Unit + Time Breakdown

1 unit (97129): 8 minutes to 22 minutes

2 units (97129 + 97130): 23 minutes to 37 minutes

3 units (97129 + 97130 + 97130): 38 minutes to 52 minutes

4 units (97129 + 97130 + 97130 + 97130): 53 minutes to 67 minutes

How much will I get reimbursed if I use these codes?

This varies depending on the state and insurance. But on average fees are paid at $35 to $55 per unit.

More Specific Questions?

What is the Difference between CPT 97129 and 97130?

Code 97129 is for the initial 15 minutes of treatment and 97130 is for any additional services provided in increments of 15 minutes. Code 97130 can only be billed after Code 97129 has been fulfilled. Please note: Code 97129 can only be billed once daily, but Code 97130 can be billed multiple times.

Can I bill 97130 alone?

No, 97130 can only be billed after the time requirements are fulfilled in 97129 (15 minutes) and at least an additional 8 minutes are completed in the session.

Can I bill 97129 alone?

Yes, 97129 can be billed alone after you spend at least 8 minutes providing face-to-face treatment.

Who can qualify for reimbursement of 97129 and 97130?

Reimbursement can only be obtained by fulfilling at least one criterion of each following section below.

Must be a Qualified Individual:
1. Physical therapists, occupational therapists, physicians, psychologists, speech-language pathologists*, nurse practitioners, clinical nurse specialists, or physician assistants.
A plan of treatment must be established before treatment begins. The plan must include:
1. the type, amount, frequency, and duration of the services that will be provided to the individual, and it must indicate the diagnosis and anticipated goals.
  1. If any changes in the plan occur then the changes must be incorporated into the plan immediately.

*Some Medicare contractors and private payers may question a speech-language pathologist’s use of codes from the 97000 series. However, CPT code 92507 is very comprehensive and generally includes all of the components of the 97129 & 97130 but with the specialization of it being designated for the use by speech-language pathologists. We recommend ASHA’s Physical Medicine Codes (97000 series) section for questions specific to these codes. For all other questions regarding the use of this question, we recommend using AOTA’s coding and billing resources center.

Do I only use this billing code for Federal or Commercial Insurance?

You can use this code for both federal and commercial insurers.

Do I have to document all of the services provided?

No. When billing 97129/97130, there is no length or note minimum of the services you are providing; However, we recommend that you fulfill the basic requirements to track the patient’s treatment plan properly

Disclosure:

HappyNeuron has compiled this information for your convenience. These guidelines do not guarantee reimbursement and are subject to obsolescence as Medicare and other payers amend their policies. All content in this document is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. The information provided was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. We will do our best to stay up to date on the latest laws and regulations.

Each patient case is unique and may require a unique combination of healthcare provider and procedure. HappyNeuron recommends that each patient condition be independently considered in terms of applicable coding and reimbursement. It is the responsibility of the medical provider and or the medical provider’s staff to make the final decision about what constitutes an appropriate diagnostic code and to understand the coverage policies for the payers they commonly bill.