They’re Here! Take Advantage of New CPT Reimbursement Codes

HOORAY! Finally, a break from stagnant reimbursement codes.

In late 2017, Congress passed the largest piece of tax reform legislation in more than three decades. Signed into law, it triggered sweeping changes, including some quite beneficial for the Physical and Occupational Therapy community. Let’s examine those aspects more closely.

Everyone is, or should be, aware that Medicare repealed reimbursement caps. This is great news! Additionally, Medicare has put in place significant fee increases for certain CPT codes. You and your clinicians need to be aware of these increases, and you must make certain that your clinicians are appropriately billing these codes.  Moreover, as we know, when Medicare sets the stage for fee changes, Workers’ Comp often follows.

Therapeutic Activity Codes vs Therapeutic Exercise Codes

Reimbursement for CPT code 97530 “therapeutic activity” has increased by 16% for 2018. This code can only be charged for therapeutic activity that is function-oriented, and not for simple, isolated strengthening or range of motion (ROM). 97530-eligible therapies include functional activities, such as gait training, task simulations, ADL, or work simulations. Use of BTE’s Primus, Simulator, or Eccentron readily supports such functional therapies and billing for this therapeutic activity code. The limit is only set by your clinical creativity.

To better measure the impact of the new reimbursements, we took a deeper look at the average changes in 97530 (and 97112) in multiple jurisdictions. We found that Medicare now pays an average of $10.30 per unit more for 97530 than 97110. Note that the lower-reimbursed CPT 97110 – “therapeutic exercise” – applies to simpler, non-functional exercises, such as TheraBand and free weights.

Workers’ Comp Codes

And more good news – Workers Comp has increased as well. The difference in Workers’ Comp reimbursement is not as large. Remember – every jurisdiction is a little different, and Workers’ Comp doesn’t necessarily match the increase of Medicare.  But, you should immediately check the charge rate for 97530 for your jurisdiction. Here’s why.

The math is powerful. If each of your clinicians is seeing 12 patients per day, and they are able to convert a total of 4 units from 97110 to 97530, that’s $40 more per day, or $200 more per week – per clinician! That’s $10,400 per year. Your clinic’s numbers may vary slightly, but the result is the same: increased revenue for your clinic!

In addition to 97530, CPT code 97112 “neuromuscular reeducation” also exceeded 97110 in billing increases. Medicare now pays an average of $4.50 per unit more for 97112 than 97110. Clinics using BTE’s Simulator, Primus and Eccentron can take advantage of this increase by simply setting a target force for the patient to watch on the screen, and control their force output accordingly.

Patient Engagement

There is even greater news here! The therapies associated with these increased CPT codes get and keep patients actively engaged in their therapy. They cannot be done at home, and (with BTE equipment), and they provide progress visuals for patients.  These provide powerful motivators for a patient to continue making and keeping appointments. In an era of high copays, giving patients strong, therapy-based motivators undeniably benefits your clinic.

All this good news on the reimbursement side of rehabilitation has been a long time coming. We encourage you to explore how codes have changed in your jurisdiction, and take the necessary steps to start charging these codes where appropriate.

If you’d like any assistance in understanding how these codes work, please contact us. We’re here to help grow your clinic.

To make sure you are getting the most out of your BTE, or – if you’ve been itching to upgrade your clinical offerings but weren’t sure how the CPT code math works out – check out this quick guide we’ve created on which CPT codes are applicable to BTE products.


John Vermette

Director of Provider and Product Management