The #1 AI-powered therapy

notes – done in seconds

Try for free

The #1 AI-powered therapy notes – done in seconds

Try for free

This blog is brought to you by YUNG Sidekick –

the #1 AI-powered therapy notes – done in seconds

This blog is brought to you by YUNG Sidekick — the #1 AI-powered therapy notes – done in seconds

Try for free – no credit card required

Home

Blog

Billing

CPT Code 97150: Essential Facts Medical Billers Need to Know in 2025

Stanley Efrem

Oct 2, 2025

Medical billing accuracy depends on understanding every code in your arsenal. CPT code 97150 represents one of the most frequently misunderstood billing scenarios in rehabilitation services—group therapeutic procedures for two or more patients [11].

This specific code requires careful attention to detail. Physical therapists, occupational therapists, speech-language pathologists, and chiropractors rely on 97150 for group sessions. Psychotherapists use entirely different coding systems for their group work. The billing process remains straightforward: one charge per patient per session, whether that session runs twenty minutes or a full hour.

Healthcare settings across the spectrum utilize this code. Outpatient rehabilitation clinics, hospitals, skilled nursing facilities, and home health agencies all implement 97150 when appropriate. Group therapy sessions often prove more effective than individual treatments, particularly when supervised by experienced healthcare providers.

Your billing accuracy affects practice revenue and compliance standing. This guide covers proper 97150 application, documentation standards, reimbursement requirements, and common errors that trigger claim denials. Master these fundamentals to ensure clean claims and optimal reimbursement for your rehabilitation services.

What CPT Code 97150 Covers and When to Use It

Proper code application starts with understanding scope and boundaries. CPT code 97150 operates under specific parameters that distinguish it from other therapy billing codes.

97150 CPT Code Description for Group Therapeutic Procedures

The American Medical Association (AMA) defines CPT 97150 as "Therapeutic procedure(s), group (2 or more individuals)" [2]. This code functions differently from timed therapy codes—billing occurs once per session regardless of duration [2]. Therapist attendance must remain constant throughout the session, though continuous one-on-one patient contact is not required. Patients might perform similar therapeutic activities like post-surgical rehabilitation exercises or aquatic therapy, or they could engage in different interventions under simultaneous supervision.

Difference Between 97150 and 97110, 97530, 97535

Code selection depends on patient contact patterns and timing requirements:

97150: Untimed group therapy code for multiple patients simultaneously
97110: Timed code (15-minute increments) for one-on-one therapeutic exercises [4]
97530: Functional performance training provided individually
97535: Self-care/home management training

Group therapeutic procedures require exclusive use of 97150—individual therapy codes should not be reported for the same treatment time [12]. Same-day billing of both individual and group codes is acceptable when sessions remain distinct and separate, requiring modifier -59 [6].

Who Uses It: PTs, OTs, SLPs, and Chiropractors

Several healthcare disciplines utilize CPT 97150:

Physical therapists
Occupational therapists
Speech-language pathologists
Chiropractors [4]

Each provider type must append appropriate modifiers (GP, GN, GO, CO, CQ) corresponding to their specific plan of care [7].

Why Psychotherapists Do Not Use 97150

Mental health professionals operate under separate coding frameworks designed for behavioral health services. Psychotherapists bill group sessions using codes like 90853 for group psychotherapy or 90849 for multiple-family group therapy. CPT 97150 applies exclusively to physical medicine and rehabilitation procedures, not mental health interventions.

Scenarios Where CPT 97150 is Applicable

Real-world applications of CPT 97150 span multiple clinical environments. Each scenario requires specific documentation and billing considerations to ensure proper reimbursement.

Group Therapy for Stroke Rehabilitation

Stroke recovery programs frequently employ group settings for optimal patient outcomes. The therapist moves between participants, providing targeted interventions while maintaining overall session supervision.

A typical session might include:

Two patients working on balance exercises
Therapist alternating attention between participants
Individual modifications provided as needed
Verbal cues delivered to multiple patients simultaneously [6]

Each participant receives one unit of 97150, since continuous one-on-one contact isn't tracked in group settings.

Fall Prevention Programs for Elderly Patients

Around three million older adults (65+) visit emergency departments annually due to falls [2]. Physical therapists address this critical health issue through structured group programs.

These sessions typically focus on:

Balance training exercises
Strength building activities
Safety education components
Coordination skill development

Documentation must clearly establish therapeutic intent for each participant. Progress notes should detail individual participation levels and measurable improvements [8].

Neurological Group Therapy for Parkinson's and Alzheimer's

Occupational therapists utilize 97150 for specialized neurological interventions. Patients with Parkinson's or Alzheimer's disease benefit from task-oriented activities designed to address motor function impairments [2].

Session characteristics include:

Multiple patients with similar neurological conditions
Simultaneous treatment delivery under constant supervision
Individual therapy goals within group framework
Focus on cognitive and physical ability restoration

Post-Surgical Conditioning in Group Settings

Post-operative rehabilitation adapts well to group therapy models. Patients recovering from similar surgical procedures participate together under single-provider supervision.

Common applications include:

Therapeutic exercise programs
Conditioning activities for recovery
Pain management technique instruction
Stress management for chronic conditions [2]

Occupational therapists may bill 97150 for group relaxation training when teaching multiple patients simultaneously.

97150 CPT Code Reimbursement and Insurance Guidelines

Reimbursement success depends on understanding each payer's unique requirements. Insurance policies vary dramatically across different plan types, making verification essential before service delivery.

Medicare's 25% Rule and Local Coverage Determinations

Medicare sets clear boundaries for group therapy utilization. The 25% rule restricts group therapy to one-quarter of total treatment time per episode of care [2].

Medicare Administrative Contractors (MACs) add another layer of specificity through Local Coverage Determinations (LCDs). These determinations establish additional parameters that may include:

Maximum group size restrictions (often four patients)
Specific therapy type limitations
Documentation requirements beyond standard Medicare guidelines [11]

Private Insurance and Medicaid Variability

Each private insurer maintains distinct coverage policies for CPT 97150. State Medicaid programs similarly establish their own parameters for group therapy services. These variations affect group size limits, session frequency allowances, and covered service definitions [2].

Verification prevents claim rejections. Contact each payer directly to confirm their specific group therapy guidelines before scheduling sessions.

Average Reimbursement Rates by Payer (2025 Estimates)

The 2025 Medicare conversion factor of $32.35 reflects a 2.8% decrease from 2024 rates ($33.29) [12]. Current reimbursement examples include:

OH BCBS Professional: $12.63
Anthem BCBS Ohio: $10.24
OH Medicaid: $14.77
CA Medicare: $14.33

How to Justify Medical Necessity for Reimbursement

Strong documentation protects against denials. Your records must demonstrate medical necessity through:

Objective measures showing patient deficits
Clear evidence of skilled therapist involvement
Individualized treatment goals for each participant
Proof that patients require professional supervision for safe completion [13]

Documentation quality directly impacts reimbursement outcomes. Detailed records support the therapeutic value of group interventions.

Avoiding Denials: Best Practices for Billing 97150

Clean claims start with proper coding practices. CPT 97150 denials often stem from preventable errors that careful attention to detail can eliminate.

Use of Appropriate Modifiers Based on Therapy Type

Modifier selection directly impacts claim processing success. Physical therapy services require GP modifiers, while occupational therapy uses GO and speech therapy applies GN [7]. Assistant-provided services need specific identification: CQ for physical therapist assistants and CO for occupational therapy assistants [14]. Medicare requires assistant modifiers when assistants deliver more than 10% of the service [14].

Avoiding Duplicate Billing for Overlapping Services

Billing errors create unnecessary claim rejections [15]. Individual therapy codes (97110-97139) cannot be billed simultaneously with group therapy (97150) for identical time periods [1]. Same-day billing becomes acceptable when sessions remain distinctly separate—append modifier 59 to demonstrate this separation [6].

Ensuring Therapist Presence and Supervision

Documentation standards require proof of constant therapist attendance throughout group sessions [16]. Simple therapist presence alone doesn't establish skilled therapy—services must demonstrate therapeutic value beyond basic supervision [17].

Verifying Group Size and Session Frequency Limits

Payer requirements vary significantly regarding group parameters [16]. Medicare generally permits group therapy to be billed only once per day per patient in private practice environments [6]. Verify specific limitations before scheduling group sessions to prevent coverage issues.

Instead of 97150, a psychotherapist would use:

Mental health billing operates under distinct coding protocols. Psychotherapists must apply behavioral health-specific codes rather than rehabilitation procedures.

CPT code 90853 for group psychotherapy sessions with multiple patients sharing a common therapeutic need or goal

Standard group psychotherapy sessions require CPT code 90853. These sessions bring together multiple unrelated clients who share therapeutic objectives [18]. Session duration typically ranges from 45-60 minutes [19] and accommodates at least three clients per therapist [18].

The billing approach differs significantly from 97150. Code 90853 focuses on individual pathology examined through group member interactions [20]. Documentation requirements include participant identification and covered diagnoses for each client when possible [5].

CPT code 90849 For multiple-family group therapy

Multiple-family group psychotherapy utilizes CPT code 90849. Several families participate together in single sessions. Common applications include families dealing with substance abuse, eating disorders, or trauma recovery.

These extended sessions run 90 minutes to 2 hours [21] and serve up to eight participants with one therapist [20]. Reimbursement varies considerably by payer. Medicare generally excludes coverage for 90849, while commercial insurers may provide reimbursement ranging from $40-$90 per family per session.

Documentation standards require individual participant records detailing session contributions and treatment goal progress [5].

Conclusion

CPT code 97150 billing requires precision, but the fundamentals are straightforward. You now have the essential knowledge to handle group therapy billing across rehabilitation disciplines with confidence.

Your documentation standards directly impact claim success rates. Proper modifier usage, medical necessity evidence, and therapist supervision records form the foundation of clean claims. Each payer brings unique requirements, yet the core principles remain consistent across insurance types.

The financial landscape for rehabilitation services continues to shift. Medicare's 25% limitation and the 2025 conversion factor of $32.35 underscore the importance of accurate coding practices. Every correctly processed claim contributes to your practice's sustainability and growth.

Group therapy billing mistakes often stem from timing conflicts between individual and group codes. Modifier -59 resolves this issue when sessions occur separately on the same day. This attention to detail protects both compliance standing and revenue streams.

Your expertise in 97150 applications strengthens the entire rehabilitation billing process. Patients receive quality group interventions while your facility maintains optimal reimbursement patterns. This balance supports both clinical excellence and operational success in today's healthcare environment.

Key Takeaways

Understanding CPT code 97150 is crucial for medical billers handling rehabilitation services, as proper application ensures accurate reimbursement and compliance with payer requirements.

• CPT 97150 is an untimed group therapy code for 2+ patients used by PTs, OTs, SLPs, and chiropractors—not psychotherapists who use different codes

• Medicare limits group therapy to 25% of total treatment time, while reimbursement rates vary significantly across payers with 2025 rates averaging $10-15

• Never bill individual therapy codes (97110-97139) simultaneously with 97150 for the same time period to avoid duplicate billing denials

• Document constant therapist supervision, medical necessity, and use appropriate modifiers (GP, GO, GN) based on therapy type to prevent claim rejections

• Verify each payer's specific group size limits and session frequency requirements before providing services to ensure coverage compliance

Proper documentation proving medical necessity and therapist involvement remains the foundation for successful 97150 claims processing and optimal reimbursement outcomes.

FAQs

Is CPT code 97150 covered by Medicare?

Yes, Medicare generally covers CPT code 97150 under its therapy benefits program. However, Medicare limits group therapy to 25% of the total treatment time per episode of care and may have specific guidelines outlined in Local Coverage Determinations (LCDs).

Do I need to use a modifier with CPT code 97150?

While CPT code 97150 typically doesn't require a modifier when billed separately, you should use appropriate modifiers based on the therapy type (e.g., GP for physical therapy, GO for occupational therapy, GN for speech therapy). If billing 97150 with other distinct services on the same day, use modifier 59 to indicate separate sessions.

Is CPT code 97150 a timed code?

No, CPT code 97150 is not a timed code. It is billed once per session regardless of the duration, unlike timed therapy codes such as 97110 which are billed in 15-minute increments.

Who can use CPT code 97150?

CPT code 97150 is primarily used by physical therapists, occupational therapists, speech-language pathologists, and chiropractors for group therapy sessions. Psychotherapists do not use this code and instead use different codes specific to mental health services.

What documentation is required for billing CPT code 97150?

To bill CPT code 97150, you must document medical necessity through objective measures, evidence of therapist involvement, individualized treatment plans, and proof that services cannot be safely performed by the patient alone. Additionally, documentation should verify the therapist's constant attendance throughout the session and detail each patient's participation and progress.