CPT (Current Procedural Terminology) codes, maintained by the American Medical Association (AMA), provide a standardized way to describe medical, diagnostic, and therapeutic procedures. CPT code 97535 is one of the most essential codes for therapy professionals, particularly within the scope of physical and occupational therapy services.
At Cures Billing Services, we simplify complex medical billing processes and ensure accurate claims for services like those covered under the 97535 CPT code.
97535 CPT codes refer to self-care and home management training provided by healthcare professionals to help patients regain independence in daily life after an illness, surgery, or injury.
97535 CPT Code Descriptions:
This code covers training in:
It’s commonly used in occupational therapy and physical therapy sessions.
Common Scenarios:
97535 CPT Code Example:
A therapist trains a stroke patient on how to dress independently using adaptive tools. The session lasts 30 minutes (billed as 2 units).
Eligible Providers:
Time-Based Billing:
Required Documentation:
Use complete medical notes or time-tracking tools to avoid denials.
Yes. When billing 97535 with other treatment codes, such as:
You may need to append modifier -59 to show that the services were distinct and separately identifiable.
97535 CPT Code Reimbursements:
Important:
Some payers require prior authorization for 97535. Always verify requirements to avoid claim denials.
In physical therapy, 97535 is used when therapists train patients to perform self-care tasks post-surgery, after injury, or during long-term care transitions.
Examples:
In occupational therapy, this code supports patients’ learning:
Stroke Recovery (OT)
Post-Surgery Rehab (PT)
CPT Code 97535 is essential in therapy billing for patients who need help regaining independence. Accurate coding, proper documentation, and payer verification are key to successful reimbursement.
At Cures Billing Services, we support therapists and clinics with end-to-end billing services to reduce denials, increase payments, and stay compliant with payer guidelines.
CPT Code 97535 refers to Self-Care/Home Management Training. This includes training in activities such as hygiene, grooming, feeding, dressing, safety procedures, and instructions in the use of assistive technology devices. It’s commonly used by occupational and physical therapists to document therapy sessions aimed at improving a patient’s daily living skills.
Qualified healthcare professionals such as occupational therapists, physical therapists, and sometimes speech-language pathologists can bill CPT 97535—provided it falls within their scope of practice and meets documentation requirements.
CPT 97535 is a time-based code billed in 15-minute increments. For every 15 minutes spent directly working with the patient on self-care training, one unit of 97535 can be billed.
To avoid denials, documentation must include:
Yes, Medicare covers CPT 97535, but only when it’s medically necessary and supported by thorough documentation. The 2025 Medicare reimbursement may vary by region, so providers should verify local fee schedules.
Common modifiers include:
Correct use of modifiers helps prevent claim denials.
You should use appropriate ICD-10 codes that support the medical necessity of self-care training. Common examples include:
Always code based on clinical evaluation and documentation.
Yes, but ensure there’s no overlap in services. It is often billed alongside:
Use modifier 59 or XE when required to indicate separate services.
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