Get Claims Paid for Caregiver Training Services (2024)

MPFS-approved codes capture provider education for caregivers to support their loved one’s daily living activities.

Recognizing the importance of caregivers to patients’ health outcomes, the Centers for Medicare & Medicaid Services (CMS) activated five CPT® codes in the 2024 Medicare Physician Fee Schedule (MPFS) final rule (CMS‑1784-F) to allow payment for caregiver training services (CTS).

CPT^® codes 97550-97552 are for therapists to report CTS. Caregiver training focuses on strategies and techniques so caregivers can help patients — who are often family members — comply with their established plans of care. CMS designates these three codes as “sometimes therapy” in the MPFS final rule.

These three new CTS codes are a welcomed collaboration of the American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA), and the American Speech-Language Hearing Association (ASHA) that created and submitted them to the CPT^® Editorial Panel and participated in their valuation.

CMS also added coverage for existing CPT^® codes 96202 and +96203 for caregiver behavior management training (CBMT) in a group setting.

CTS Codes and Part B Payment

According to a CMS.gov Newsroom press release, “CMS will pay for certain caregiver training services in specified circ*mstances, so that practitioners are appropriately paid for engaging with caregivers to support people with Medicare in carrying out their treatment plans.” These services are optional, and the patient must give consent.

The CPT^® codes are:

97550 Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLS], instrumental ADLS [IADLS], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes

+97551 … each additional 15 minutes (List separately in addition to code for primary service)

97552 Group caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLS], instrumental ADLS [IADLS], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers

Who Can Bill for CTS?

According to APTA, the sometimes therapy caregiver training codes are likely to be used by physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). The training can cover therapy training for a broad range of skills, from assisting with activities of daily living to more complex tasks such as transfers, mobility, communication, and safety practices. CTS codes should be used when only the caregiver(s) is present for training and the patient is not present.

Medicare covers caregiver training codes in all office/outpatient settings, such as private practices, hospital outpatient, skilled nursing facilities, rehabilitation agencies, and home health. Medicare pays for caregiver training given by a physician or a non-physician practitioner (i.e., nurse practitioner, clinical nurse specialist, certified nurse-midwife, physician assistant, and clinical psychologist) or a therapist (PT, OT, or SLP) as part of the patient’s individualized treatment plan or therapy plan of care (POC).

Documentation Requirements

Let’s define who is considered a caregiver, as applies to codes 97550-97552, and how CMS recognizes caregivers when reporting caregiver training services. In the 2024 MPFS final rule, CMS provides two definitions for caregiver:

An adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation.
A family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.

The APTA says for PTs to report 97550-97552, the PT must report the code(s) as part of the PT POC, and the patient’s consent for CTS “must be specific to the services and documented in the medical record.” The treating practitioner must document each occurrence of CTS and its need in the medical record to support medical necessity.

The APTA provides helpful tips and guidance through its “APTA Practice Advisory: CPT® Codes for Caregiver Training Without the Patient Present” document, available on the APTA website. The APTA’s guidance to help get claims paid includes:

Because this training procedure is intended to meet a very specialized need for a select group of patients, it generally will not be the only means of caregiver training for any patient.
Normally, the standard for providing caregiver training is to do so with the patient present. Deviating from this standard calls for only reporting these new codes when necessary, and documentation must support the reason for the deviation.
When provided by a PT, this service is reported as part of a PT POC, indicating when a more intense interaction with the caregiver without the patient present is necessary to ensure proper skill development by the caregiver.
When providing caregiver training for a single patient, codes 97550 and +97551 are reported based on the time spent training, regardless of how many caregivers are present for the training.
When providing group training to multiple sets of caregivers, with each set of caregivers representing a separate patient, code 97552 should be reported per patient represented, not per caregiver present.

CBMT Gains Support

In 2023, CPT^®added the Behavioral Management Services subsection and two new codes in the Medicine section. The two CBMT codes had a status indicator of B, which means Medicare bundled them into other unspecified services and no RVUs or payment amounts were made to reimburse these services. Effective Jan. 1, 2024, the work RVUs for 96202 is 0.43 for up to 60 minutes of total time and 0.12 for +96203, once 75 minutes of total time are reached.

The CBMT codes are:

96202 Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes

+96203 … each additional 15 minutes (List separately in addition to code for primary service)

These CBMT codes report provider teaching of caregivers in a group setting without the patient present. They are for caregiver education for managing/modifying behavior through procedures, strategies, and interventions for patients with a mental or physical health diagnosis that requires a treatment POC.

The OIG Will Be Watching

CMS has expressed concern that these services could be duplicative of other training that a caregiver receives, and the Office of Inspector General (OIG) will most likely monitor claims for improper payments.