CPT code 97112
CPT code 97112 is used to bill skilled therapy interventions that aim to improve overall motor function by stimulating the nervous system under Neuromuscular Reeducation.
Occupational therapists use these skilled neuromuscular reeducation techniques to help patients improve control of their bodies by targeting neural pathways and the communication between their brain and body. This article covers what interventions fall under CPT code 97112 and how these techniques differ from similar procedures used in therapy treatment plans.
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What is CPT code 97112?
Specifically, the neuromuscular reeducation procedure code is a timed code that includes the reeducation of balance, movement, kinesthetic sense, coordination, posture, and proprioception for sitting and standing activities. Procedures covered by this code include interventions that require assistance and cueing for the body’s position in space, balance, coordination, and strength to perform daily activities.
An example may be teaching a patient how to activate muscles in their shoulders and back to promote improved posture and reach during ADLs after a brain injury. Neuromuscular reeducation differs from therapeutic exercise in that neuromuscular reeducation requires specific cueing and assistance to stimulate the neuromuscular system and promote functional movement.
Medical necessity and coverage criteria will rely on objective measurements collected during the evaluation and goals listed in the patient’s treatment plan. Like other CPT codes, the treatment procedure billed must be directly related to goals included in the treatment plan and illustrate how interventions will improve overall daily performance.
When documenting the skill required and treatment outcome, describe how treatment addressed components within the definition of neuromuscular reeducation. Since CPT code 97112 is a timed code, it will follow the 8-minute rule by most payors and require direct, one-on-one intervention. No other codes can be billed, nor can the same 15-minute time increment be shared with another patient.
Additional restrictions reported by the Centers for Medicare and Medicaid Services (CMS), state that CPT code 97112 cannot be billed with a group code or paired with an untimed code such as an evaluation for the same time. Refer to the CMS website billing and coding information for additional guidance on restricted CPT code usage.
Documentation to support medical necessity include documenting the skilled nature of treatment (type of assistance required, how much assistance was required), why treatment was used, patient comments regarding pain, treatment outcome, goals supported by treatment, education provided, and if supervision was provided for another treating therapist. CMS also states that therapists should document skilled components of treatment if the same treatment is repeated over several sessions, so the treatment does not appear repetitive and unskilled.
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CPT Code 97112 and occupational therapy
Occupational therapy services covered by CPT code 97112 include facilitating muscle contractions in an individual’s arm to perform ADLs, helping improve balance and posture when retrieving items from a closet or addressing ergonomic principles to reduce risk or injury or pain.
Additional services included but not limited to within neuromuscular reeducation are Proprioceptive Neuromuscular Facilitation (PNF), desensitizing techniques, and kinesthetic training.
Sometimes, modalities such as electrical stimulation are used to facilitate muscle contractions or aid in desensitization during therapy but are generally not billed separately for the same treatment time per CMS guidelines.
Because CPT code 97112 is timed and requires direct one-to-one treatment, it is billed alone for the same treatment time. Functional electrical stimulation and neuromuscular electrical muscle stimulation may be billed when the therapist is applying, managing pads, or educating the patient but generally not billed at the same time as CPT code 97112. Neuromuscular reeducation fits into occupational therapy treatment plans as therapists reeducate patients how to control their body for the greater purpose of regaining functional independence in a daily routine.
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Maximizing reimbursement for CPT code 97112
Common reimbursement issues include inaccuracies with aligning total treatment time minutes to units charged and missing information regarding how procedure was skilled or necessary. Timed codes require direct, one-on-one, skilled service from a qualified professional for a minimum of 8 minutes for one unit. Many resources often refer to timed codes in 15-minute sections as this is the average length of a treatment and therapists commonly divide treatment sessions into 15-minute increments. So, if you spent 15 minutes providing neuromuscular reeducation and 10 minutes on self-care/home management, you would charge one unit for neuromuscular reeducation and one unit for self-care/ home management with a total treatment time of 25 minutes.
Allowable units when billing timed procedure codes
1 unit | 8-22 minutes |
2 units | 23-37 minutes |
3 units | 38-52 minutes |
4 units | 53-67 minutes |
How many units of CPT code 97112 can you bill?
Billing for CPT code 97112 is limited to no more than 4 units per date of service per discipline as stated on the CMS website. CMS notes that treatments should rarely exceed 30-60 minutes, with longer sessions requiring documentation to support a lengthier duration. Use a reliable chart for timed procedure codes and review updated definitions of procedure codes to help you correctly determine total treatment time and procedure time to avoid denials or inaccurate reimbursement for your services. Additional billing tips include planning ahead at how you will divide your treatment time and consider efficient ways to prepare sessions for maximized treatment time.
Key documentation elements for reimbursement success include ensuring required information is included in your treatment notes. Information such as treatment date, signature, therapist credentials, record of total treatment time, signatures of treating therapists and procedure specifics are all necessary components of a treatment note. In the medical record itself, therapists should make sure appropriate outcome measures are included from ordering provider, medical history, test results, and a signed visit record of patient receiving therapy for conditions requiring skilled therapy. Missing required information in your treatment note can deem your documentation incomplete and your claim may be denied.
CPT Code 97112 and compliance
For compliance, you need to have neuromuscular reeducation performed by a qualified professional, providing direct skilled intervention for a minimum of 8 minutes per unit.
Documentation should support the skills required and how the procedure aligns with the definition of CPT code 97112 to support the clinical judgment.
Providers are also encouraged to maintain records of education and training to support the skilled use of these techniques in the case of an audit or adverse event. Common compliance risks include charging for neuromuscular reeducation when a non-qualified professional is charging for CPT code 97112, sub optimal supervision for professionals or students delivering neuromuscular reeducation and sharing treatment time with other patients or restricted procedures.
CPT code 97112 requires direct, hands-on, one-on-one skilled service that cannot be charged with another procedure code or share the same time window as another patient if there is a concurrent session. If the patient progresses to perform activities or exercises at a supervision level, they no longer qualify for that treatment time being billable under CPT code 97112 and a different procedure code should be considered.
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Neuromuscular reeducation plays a vital role in helping improve motor control of the body and promoting patients to attend to their proprioceptive system as they learn to listen to their body and improve functional movements.
Overall, these exercises help people achieve greater independence for functional tasks which fit securely in an occupational therapy plan of care. This procedure code has specific parameters that therapists should be aware of to avoid insurance denials. Luckily billing guidelines can be found at the Centers for Medicare and Medicaid Services (CMS), and your respective insurance payor provider guidelines.
How EHR and practice management software can save occupational therapists time on insurance billing
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers OTs significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save occupational therapy providers time when it comes to insurance billing for therapists.
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including occupational therapists in group and solo practices.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
- Practice management tools
