Basics of CPT codes 97550-97552
For the Current Procedural Terminology (CPT) 2024 code set effective January 1, 2024, a new subsection within the Medicine section containing three new CPT codes (97550-97552) has been established. These new codes describe training provided to the patient that includes strategies and techniques to assist with functional activities by a physician or other qualified health care professional (QHP) of a caregiver without the patient present.
New guidelines have also been established to guide users to the appropriate code(s) to report based on the time involved, as well as whether the caregiver(s) is being trained alone or as part of a group session involving the caregivers of multiple patients. The new codes address a gap in current coding for reporting skilled training provided by a physician or other QHP to caregivers of patients to reduce caregiver burden and to safely support the patient’s functional performance in their activities of daily living (ADLs) and the pursuit of therapy goals as outlined in the patient’s plan of care. This article provides an overview of the new codes and describes their intended use.
Medicine
Physical Medicine and Rehabilitation/Therapeutic Procedures
Caregiver training is direct, skilled intervention for the caregiver(s) to provide strategies and techniques to equip caregiver(s) with knowledge and skills to assist patients living with functional deficits. Codes 97550, 97551 are used to report the total duration of face-to-face time spent by the qualified health care professional providing training to the caregiver(s) of an individual patient without the patient present. Code 97552 is used to report group caregiver training provided to multiple sets of caregivers for multiple patients with similar conditions or therapeutic needs without the patient present.
During a skilled intervention, the caregiver(s) is trained using verbal instructions, video and live demonstrations, and feedback from the qualified health care professional on the use of strategies and techniques to facilitate functional performance and safety in the home or community without the patient present. Skilled training supports a caregiver’s understanding of the patient’s treatment plan, ability to engage in activities with the patient in between treatment sessions, and knowledge of external resources to assist in areas such as activities of daily living (ADLs), transfers, mobility, safety practices, problem solving, and communication.
These services do not represent therapeutic interventions requiring direct one-to-one patient contact.
Description of CPT code 97550, 97551 and 97552
97550 Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, 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
+97551 each additional 15 minutes (List separately in addition to code for primary service)
(Use 97551 in conjunction with 97550)
97552 Group caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, 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
Codes 97550-97552 have been established to report skilled training provided by physicians or other QHPs to caregivers of patients, which consists of strategies and techniques to assist patients who have functional deficits with ADLs and achievement of therapy goals. Code 97550 will be used to report a time-based skilled training session for the initial 30 minutes with the caregiver(s) of a patient, while add-on code 97551 is used to report each additional 15-minute increment of the skilled training session, as needed. Code 97552 is intended to describe a group session for caregivers in which skilled training is facilitated by a physician or other QHP for the caregivers of multiple patients in a group setting. Note that there is no required time specified in the code descriptor because time may vary for group sessions.
For either type of caregiver training (individual or group), the physician or other QHP provides training intended to ensure the caregiver’s competence in and ability to perform strategies and tasks that support the patient’s functional performance and achievement of therapy goals while addressing safety issues and mitigating the risk for adverse events. The content of the patient’s treatment plan is also shared with and explained to the caregiver, which enables the caregiver to engage in various activities with the patient between treatment sessions and to provide resources and information that empower the caregiver to better care for and support the patient in goal achievement.
In addition, the new guidelines further define caregiver services and remind users that these codes may not be reported when direct one-to-one patient contact is needed; rather, these codes are intended to be reported when only the caregiver is present with the physician or other QHP for training purposes.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.
Clinical Example (CPT code 97550)
The caregiver(s) of a 75-year-old male, who has right hemiparesis and visual/perceptual and cognitive deficits because of a stroke, requires caregiver training. Patient’s symptoms result in communication deficits and cognitive functioning limited to following one-step directions, making functional management difficult. Direct (one-on-one) training is provided to the caregiver(s) to facilitate management of activities of daily living (ADLs), transfers, mobility, communication, and problem solving to enable the caregiver(s) to effectively facilitate a home-management program.
Description of Procedure (97550)
The QHP provides skilled intervention as part of a therapy plan of care to introduce strategies and techniques to the caregiver(s) to assist the patient living with functional deficits and to competently guide completion of ADLs that may include patient safety instruction; 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 (eg, 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 QHP guides and assesses return demonstration by the caregiver(s) of activity or task performance required to ensure safety and efficient completion. The QHP addresses the caregiver’s questions and concerns and provides resources as needed. The QHP documents caregiver(s) training in the medical record.
Clinical Example (CPT code 97551)
The caregiver(s) of a 75-year-old male, who has right hemiparesis and visual/perceptual and cognitive deficits because of a stroke, requires additional caregiver training. Patient’s symptoms result in communication deficits and cognitive functioning limited to following one-step directions, making functional management difficult. Direct (one-on-one) training is provided to the caregiver(s) to facilitate management of ADLs, transfers, mobility, communication, and problem solving to enable the caregiver to effectively facilitate a home-management program.
The caregiver(s) requires an additional 15 minutes of training beyond the initial 30 minutes. [Note: This is an add-on code. Only consider the additional work related to code 97551 caregiver training in strategies and techniques to facilitate patient’s functional performance.]
Description of Procedure (CPT code 97551)
The QHP continues to provide skilled intervention as part of the therapy plan of care to introduce strategies and techniques to the caregiver(s) to assist patient living with functional deficits and to competently guide completion of ADLs that may include patient safety instruction; 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 (eg, 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 QHP guides and assesses return demonstration by the caregiver of activity or task performance required to ensure safety and efficient completion. The QHP addresses the caregiver’s questions and concerns and provides resources as needed. [Note: This is an add-on code. Only consider the additional work spent by the QHP performing caregiver functional skills training beyond the initial 30 minutes reported with code 97550.]
Clinical Example (CPT code 97552)
The caregiver(s) of a 75-year-old male, who has right hemiparesis and visual/perceptual, communication, and cognitive deficits because of a stroke, participates in group-based training to facilitate and support patient’s functional performance in management of ADLs, transfers, mobility, communication, and problem solving in the home or community. The training provides the caregivers the opportunity to ask questions and engage in group problem solving around caregiver challenges.
Description of Procedure (97552)
The QHP initiates group-based skilled intervention as part of a therapy plan of care to introduce strategies and techniques to the caregivers to assist patient living with functional deficits and to competently guide completion of ADLs that may include patient safety instruction; 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 (eg, 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.
As appropriate, the QHP facilitates group problem solving to enhance generalizability of concepts across participants. The QHP guides and assesses return demonstration by the caregivers of activity or task performance required to ensure safety and efficient completion. The QHP addresses the caregivers’ questions and concerns and provides resources as needed. The QHP documents caregivers’ training in the medical record.
Reference : CPT assistant November month
