Missed CMS's Q1 Webinar? What You Need to Know about the 3 New Caregiver Codes

In November of last year, we announced that Medicare would allow three new caregiver CPT codes to be billed and reimbursed (other payors may also be reimbursing for these) in the outpatient therapy setting starting January 1st, 2024.  While the APTA created a practice advisory, this resource is only available for APTA members. Many owners and therapists have been asking about these codes and how to implement them into practice. To fill this gap, we’ve compiled definitions and takeaways below.

First, a caregiver is defined as “an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation.” This means that a “family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition” would be considered a caregiver. Simple?... Not exactly. 

Here is a brief review of the three caregiver definitions per CPT code:

97550 - Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices), face to face; initial 30 minutes.

97551 - Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices), face to face; each additional 15 minutes.

97552 - Group caregiver training (multiple patients’ caregivers e.g. three sets of caregivers representing three different patients) in strategies and techniques to facilitate the patient's functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices), face to face with multiple sets of caregivers.

Key Point: The patient must provide consent for this service but is not allowed to be present during the caregiver training (by definition). Your documentation must outline and justify why these services are necessary and included with all other services in your initial plan of care (best practice).

Final Thought: Most therapists already have experience with this service but were unable to effectively capture this during the billing process. Now we can include this service in a patient’s plan of care, obtain patient consent, educate caregivers when the patient is not present and bill accordingly with these three new CPT codes!

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