Success in Getting Paid Using New Caregiver Education Codes

CMS has approved 97550 timed code first 30 minutes, 97751 add on code with 97550, Caregiver Education codes for OT PT and ST effective 1/1/2024. Although CMS is the gold standard for commercial carriers and many follow their lead in approving CPT codes, do not assume that all carriers will automatically approve and pay for the codes. Additionally, as with all codes, these are not adult or pediatric driven. The purpose of this survey is to gather preliminary data on not only whether therapists are using these codes, but also whether they are being acknowledged and paid for/reimbursed by carriers across the country. Educating is at the cornerstone of what we do as therapists – now, let’s see how far we have come in getting paid for it. The results of the survey will be shared with everyone. Thank you for your participation.
1.Did you start using Caregiver Education Codes beginning January 1 2024, 97750 and 97751, following the CPT description of what is allowed under the code(s)?
2.Please check which category of patients best describes your practice.
3.For those in network pediatric practices actively billing the codes, please list your city, state, any payors who have honored the codes and the rate of reimbursement.
4.For those OON peds, please list the city/ state you practice in, the insurance carrier billed, and the amount that was paid for the code(s).
5.For those in or out of network Peds practice, if you have been denied payment for the codes, please list your city/state, the payor, and the listed reason on the EOB why payment was denied -ie non covered service, documentation does not support code etc
6.In network adult practices treating patients under 65 years of age, if you got reimbursed for codes 97750 and 97751?, please let us know your city/state, the amount paid and the payor.
7.OON practices treating patients under 65, if you were reimbursed under assignment of benefit or your clients reimbursed for codes 97750 and 97751, please list your city/state, payor and amount paid.
8.All practices treating adults under 65, If the codes were denied, please share the reason why - ie non covered service, documentation does not support the code etc.
9.Medicare Non Par therapists - if you have started using the caregiver education codes, please let us know if they have been paid, and if so, list the amount, the city/state where you are practicing. If you have been denied please share the EOB explanation.
10.Medicare PAR therapists, if you have started using the caregiver education codes, please let us know if they have been paid, and if so, list your city/state, an amount paid. If charges were denied, please share the EOB explanation.