Group Therapy - June 7, 2023

PT and OT: 97150

SLP: 92508

Report the group therapy code for each member of the group.  Group therapy procedures involve constant attendance of the therapist or assistant, but by definition do not require one-on-one patient contact.

Group therapy consists of therapy treatment provided simultaneously to two (2) or more patients who may or may not be doing the same activities. If the therapist is dividing attention among the patients, providing only brief, intermittent personal contact, or giving the same instructions to two (2) or more patients at the same time, 

Examples of Group Therapy

Example 1:  In a twenty-five (25) minute period, a therapist works with two patients, A and B, and divides his/her time between the two (2) patients.  The therapist moves back and forth between the two (2) patients, spending a minute or two at a time, and provides occasional assistance and modifications to patient A’s exercise program and offers verbal cues for patient B’s gait training and balance activities on the parallel bars. The therapist does not track continuous identifiable episodes of direct one-on-one contact with either patient. The appropriate coverage is one (1) unit for each patient.

Example 2:  In a forty-five (45) minute period, a therapist works with three (3) patients - A, B, and C - providing therapeutic exercises to each patient with direct one-on-one contact in the following sequence:  Patient A receives eight (8) minutes, patient B receives eight (8) minutes and patient C received eight (8) minutes.  After this initial twenty-four (24) minute period, the therapist returns to work with patient A for ten (10) more minutes (18 minutes total), then patient B for five (5) more minutes (13 minutes total), and finally patient C for six (6) additional minutes (14 minutes total).  During the times the patients are not receiving direct one-on-one contact with the therapist, they are each exercising independently. The therapist appropriately bills each patient one (1) fifteen (15) minute unit of therapeutic exercise.

Limitations

One (1) unit is appropriate per patient per visit.

Groups should be limited to no more than four (4) group members.

Group therapy should not represent the entire plan of treatment.

Documentation

If group therapy is billed on a given day, it must be listed in the treatment note. The minutes of this untimed code must be added to the Total Treatment Time for that day. Further documentation describing the skilled nature of the group session documented in the progress report or the treatment note may assist in supporting the medical necessity of the service.

Supportive documentation recommendations for group therapy:

• The purpose of the group and the number of participants in the group
• Description of the skilled activity provided in the group setting, such as instruction in proper form, or upgrading the difficulty of the activity for an individual.

Services Not Covered

Supervision of a previously taught exercise program or supervising patients who are exercising independently is not a skilled service and is not covered as group therapy or as any other therapeutic procedure. Supervision of patients exercising on machines or exercise equipment, in the absence of the delivery of skilled care, is not a skilled service and is not covered as group therapy or as any other therapeutic procedure.

Non-covered as group therapy:

• Groups directed by a student, therapy aide, rehabilitation technician, nursing aide, recreational therapist, exercise physiologist, or athletic trainer;
• Routine (i.e., supportive) groups that are part of a maintenance program, nursing rehabilitation program, or recreational therapy program;
• Groups using biofeedback for relaxation;
• Viewing videotapes; listening to audiotapes;
• Group treatment that does not require the unique skills of a therapist.

Reference

Centers for Medicaid and Medicare.  Benefit Manual Chapter 15 § 230

LCD: Outpatient Physical and Occupational Therapy Services L34049

LCD: Speech-Language Pathology L34046