As of January 1, 2018, payers may accept a Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) code for therapeutic services aimed at development of cognitive skills. Behavioral health care professionals, such as physicians and psychologists, will typically report CPT code 97127 for therapeutic interventions focused on cognitive function and compensatory strategies to manage the performance of an activity. However, for plans that adopt Medicare policy, HCPCS code G0515 may be required.

HCPCS code G0515 was developed by the Centers for Medicare & Medicaid Services (CMS) because the Medicare program has elected not to pay for services reported with code 97127. This was necessary because code 97127 is reported per encounter/day but replaced code 97532 (same descriptor as G0515), which was reported and valued for 1 unit per 15 minutes of service. The CMS noted that historical claims data indicated that occupational...

You do not currently have access to this content.