2025 CPT code 97130
(Active) Effective Date: N/A Medicine - Physical Medicine and Rehabilitation Feed
Therapeutic interventions for cognitive function (e.g., attention, memory, reasoning) and compensatory strategies to manage activities, direct one-on-one patient contact; each additional 15 minutes (List separately in addition to code for primary procedure).
This code may be subject to payer-specific modifier rules.
Medical necessity is established by documenting a diagnosis that affects cognitive function, such as traumatic brain injury, stroke, learning disability, autism spectrum disorder, or other neurological or medical conditions. The documentation should demonstrate functional deficits and how the therapy addresses specific cognitive impairments to improve the patient's ability to perform daily activities.
The physician or other qualified healthcare professional provides direct, one-on-one contact with the patient, delivering skilled therapeutic interventions. They assess and address cognitive deficits and help patients develop compensatory strategies to improve functional performance in daily activities.
In simple words: The provider works directly with the patient to improve cognitive skills like thinking, remembering, and problem-solving, and to develop strategies for managing daily tasks. This code is used for each 15 minutes of therapy after the initial 15 minutes (billed separately with code 97129).
This code represents additional 15-minute intervals of direct, one-on-one therapeutic interventions focusing on cognitive functions (such as attention, memory, reasoning, executive function, problem-solving, and pragmatic functioning) and compensatory strategies to help patients manage the performance of activities (e.g., managing time, organizing tasks). It is used in conjunction with the base code 97129 (for the first 15 minutes) and should not be reported alone.
Example 1: A patient with a traumatic brain injury receives cognitive therapy to improve memory and attention. The therapist bills 97129 for the first 15 minutes and 97130 for each additional 15-minute block of therapy provided during the session., A child with a learning disability receives therapy to improve organizational and planning skills. The therapist provides one-on-one interventions and bills 97129 for the first 15 minutes and then two units of 97130 for 30 additional minutes. , An individual with a neurological condition receives therapy to address difficulties with problem-solving and executive function. The therapist utilizes compensatory strategies and bills the appropriate combination of 97129 and 97130.
Documentation should support the medical necessity of the cognitive intervention and specify the total direct (one-on-one) time spent with the patient, the type of interventions used, and the patient's progress.
- Specialties:Physical Medicine and Rehabilitation, Occupational Therapy, Speech-Language Pathology, Psychology
- Place of Service:Outpatient Hospital, Office, Inpatient Hospital, Skilled Nursing Facility,Home, and other places of service where therapy is provided