Coding and Billing for Outpatient Rehab Made Easy

❚❘❘ CPT codes
97537—Community work/reintegration training. This code would be used when the
focus of treatment is on helping the patient with function in the community. Treatment
aspects could include shopping skills, money management, transportation, work environment/modification
analysis, task analysis, and training in assistive technology
device and adaptive equipment.
Tip: Do not bill Medicare and other third-party payers for 97537 if the treatment
focused on work environment/modification analysis, or work task analysis. Medicare
and other third-party payers may deny claims for 97537 because they may feel that
they should not be paying to get someone back to work. That typically falls under
workers’ compensation or automobile claims.
97542—Wheelchair management. Beginning January 1, 2006, this CPT code includes
time spent on assessment, fitting, and training. Assessment includes, but is not limited
to, determining the patient’s need for a wheelchair, determining the type of wheelchair
required, and assessing the patient’s ROM and strength, endurance, skin integrity, sensation,
sitting balance, transfer ability, etc. 15 This code includes instructing the patient
or caregiver in how to
• propel or maneuver the wheelchair
• open and close the wheelchair
• lock/unlock the brakes
• remove and put on the arm rests, foot rests, and leg rests
97545—Work hardening/conditioning, initial two hours. This CPT code is not reimbursed
by Medicare or by many other insurance carriers, other than workers’ compensation
and auto coverage.
97546—Work hardening/conditioning, each additional hour. This CPT code is not reimbursed
by Medicare or by many other insurance carriers, other than workers’ compensation
and auto coverage.
© 2006 HCPRO, INC. CODING AND BILLING FOR OUTPATIENT REHAB MADE EASY
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