Recreational therapy is an essential service for many individuals with disabilities, including those recovering from traumatic brain injuries (TBI), chronic illnesses, or physical and mental health challenges. Community-based providers, often serving patients with Medicaid, private insurance, or self-pay, must choose the correct CPT code to bill for these therapeutic activities. While Medicare providers commonly use G0176, this code may not be reimbursed by non-Medicare insurers. For community-based providers working outside the Medicare system, the best alternative CPT codes for recreational therapy are 97110 (Therapeutic Exercises) and 97530 (Therapeutic Activities). Here’s why these codes are appropriate and how to apply them effectively.
- Why CPT Code 97110 and 97530 Are Suitable Alternatives for Recreational Therapy:
CPT Code 97110 is designated for “Therapeutic Exercises to develop strength, endurance, range of motion, and flexibility,” billed in 15-minute increments. This code is well-suited for recreational therapy sessions that focus on physical improvement and functional restoration. Many recreational therapy activities — such as adapted sports, balance exercises, and strengthening movements — align with the purpose of CPT Code 97110, making it an appropriate choice for community-based providers who need to justify the medical necessity of therapeutic exercises.
CPT Code 97530, on the other hand, covers “Therapeutic Activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance),” also billed in 15-minute increments. This code is particularly useful for recreational therapy sessions that aim to improve patients’ daily functioning through structured, goal-oriented activities. For instance, adaptive activities like gardening, art therapy, or games that work on cognitive and motor skills are all viable examples under 97530. This code allows community-based providers to justify a broad range of activities, emphasizing functional improvements in real-life scenarios, rather than purely physical outcomes.
2. Benefits of Using 97110 and 97530 for Non-Medicare Billing:
Using CPT codes 97110 and 97530 provides several advantages for non-Medicare providers. First, these codes are widely accepted by private insurance companies and Medicaid, improving the likelihood of reimbursement. Both codes are also flexible, allowing providers to adapt their therapeutic sessions based on the specific needs of the patient. Recreational therapy often involves a mix of physical and functional improvement activities, and these codes help providers reflect the diversity of therapeutic benefits that recreational therapy offers.
By using 97110 and 97530 strategically, community-based providers can ensure that their recreational therapy sessions are both reimbursable and clinically justifiable. This not only supports the financial viability of providing these services but also underscores the therapeutic value of recreational activities, helping patients achieve physical and cognitive improvements in a holistic, engaging manner.
Another Blog Post by Direct Care Training & Resource Center, Inc. Photos used are designed to complement the written content. They do not imply a relationship with or endorsement by any individual nor entity and may belong to their respective copyright holders.
| Follow us in the Social Stratosphere… | ||||
|
