CPT code 97535: Self-care/home management training

What is the 97535 CPT code?

CPT code 97535 is a time-based code used to bill for self-care/home management training. It specifically refers to training in self-care and home management skills to improve a patient's ability to perform daily living tasks independently.

Examples of such activities of daily living (ADLs) include:

• Training in personal hygiene
• Meal preparation and safety
• Home safety procedures
• Transfer techniques
• Energy conservation techniques
• Joint protection strategies
• Compensatory training strategies for home activities
• Use of assistive devices/adaptive equipment and assistive device or adaptive equipment training
• Home injury, symptom, or pain management

Occupational therapists and physical therapists often provide these activities and services to patients recovering from injuries, surgeries, or managing chronic conditions, and are most likely to frequently use this code.

97535 CPT code documentation requirements

To demonstrate the medical necessity and skilled nature of the services provided, comprehensive and accurate documentation is crucial. To ensure proper reimbursement, ensure that the patient's medical records have the following key elements:

• Objective measurements of the patient's ADL abilities and functional limitations
• Details of the training provided from functional deficits are addressed to specific skills taught or practiced
• Compensatory training strategies were taught
• Type of assistive devices or equipment used and their role in assisting the patient, if applicable
• Duration of the session (preferably in 15-minute increments)
• Patient's response and progress towards goals in their active treatment plan
• Rationale of the intervention or details on the medical necessity

Billing guidelines

For accurate billing and maximizing reimbursement, the following guidelines must be followed:

• The code is billed in 15-minute increments
• You must provide at least 8 minutes of the service according to the "8-minute rule."
• There must be direct one-on-one contact between the licensed therapist and the patient.
• The therapist must establish medical necessity and provide proof that the service(s) provided meet the medical necessity criteria
• The interventions must be aligned with the treatment plan
• Specific modifiers are used or added as some payers may require the GP modifier (outpatient physical therapy services) or the GO modifier (outpatient occupational therapy services).
• Adherence to the specific billing guidelines and policies of individual insurance companies.