New Caregiver Training CPT Codes for PT, OT, & SLP: A Care and Reimbursement Opportunity

New Incentives to Provide Caregiver Training

Providers of rehabilitation services (including PT, OT, and SLP) in outpatient, private practice, and other settings billing Medicare Part B have a new tool for the new year. The CY 2024 Physician Fee Schedule created three new CPT codes for a new caregiver training service:

• 97550, a 30-minute caregiver training code
• 97551, a 15-minute follow-up code
• 97552, a group caregiver training code. 

The codes are reimbursable by Medicare and potentially other commercial insurance (please check with your payers for their coverage policies).

Let’s take a closer look at these codes and help you decide if this is an opportunity your organization should be taking advantage of. 

What Is Caregiver Training?

CMS describes a caregiver training service (CTS) in the code description as “training in strategies and techniques to facilitate the patient’s functional performance in the home or community.” These strategies and techniques would be focused on improving the patients’ performance of their activities of daily living (ADLs) and instrumental ADLs (IADLs).

CMS notes in the Final Rule that services provided on behalf of the patient—but when the patient is not present—have not historically been considered covered services. CTS, however, is a significant change to that policy. CMS now considers that training is “reasonable and necessary” for caregivers when they are important for treatment of the patient after the plan of care is established. Training needs to be “congruent with the treatment plan and designed to effectuate the desired patient outcomes,” and CTS may be needed in particular when the patient could have difficulty following through with the treatment plan on their own. 

Caregiver Definition Updated

In the Final Rule, CMS also updates the definition of “caregiver” for providing the caregiver training service. CMS recognizes caregivers 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,” or “a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.”

Who Can Use the New CTS Codes?

PTs, OTs, SLPs and other qualified healthcare professionals, including PTAs and COTAs under supervision, can provide caregiver training services as part of an established plan of care. The codes are “sometimes therapy” codes, meaning that a physician is able to bill for CTS outside of a therapy plan of care when appropriate. 

CMS allows PTs, OTs, and other qualified healthcare professionals to provide the caregiver training service on a face-to-face basis, meaning the codes can not be provided via telehealth or virtual visit at this time. CMS intends for the codes to be provided when the patient is not present. Providers can start billing the three codes now; they have been available since January 1, 2024.

The New CTS CPT Codes

Complete information can be found in this section in the Final Rule:

• 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) (without the patient present), 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) (without the patient present), face-to-face; each additional 15 minutes.

• 97552 – Group 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) (without the patient present), face-to-face with multiple sets of caregivers.

Reimbursement

The rates below are the national payment amounts for facility and non-facility Medicare Part B providers billing CTS codes. Refer to the lookup tool to determine the rate for your MAC or locality. We also strongly recommend your organization check with your payer for more information. 

Want More Information on the CTS Codes? We Recommend These Resources

For providers and organizations considering offering caregiver training services to patients, we recommend engaging stakeholders in your organization and seeking guidance from your payers. But first, review the additional information available from your association—the APTA, AOTA, and ASHA each offer guidance on the new codes to help you get started.

And, remember, when billing outpatient therapy services for Medicare Part B, use the 8 minute rule for time-based CPT codes.