Therapeutic Activity (97530) can no longer be billed with PT/OT initial evals

January 13, 2020
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CMS slipped in surprise CCI edits that are effective for dates of service on and after January 1, 2020. These have caught virtually everyone off guard and PTs and OTs are likely to see notices and calls to action from the APTA, AOTA, etc.

The most significant change is that 97530 (therapeutic activities) can no longer be billed with an initial PT or OT evaluation.  You will not be able to use a 59 modifier to charge 97530 with an initial evaluation. Note that you can continue to bill other timed codes, such as 97110, 97112 and 97140 with an initial evaluation. However, you will now be required to use a 59 modifier if you bill 97140 (manual therapy) with an initial evaluation.

Although this should be less significant, CMS will no longer allow 97150 (group therapy) to be billed with 97530.