Insurance coverage varies according to insurance company and state, but all major carriers now cover Cognitive Rehabilitation. It is billed in 15 minute units with fees paid at $35 to $55 per unit, depending on the region of the country. A treatment plan is required and progress must be documented. In addition, the patient needs to be qualified to show that he or she can possibly benefit from this form of treatment. Currently, neurological disorders, strokes, cancer treatment (medicines used to treat cancer are toxic to the brain) and traumatic brain injuries are covered. Alzheimer’s is usually not covered. It is recommended that a prescription for cognitive rehabilitation be obtained from the treating physician and that the clinician also call the insurance company involved if there are specific concerns regarding the client’s policy.
These are multidisciplinary codes that can be used by any healthcare professional qualified to provide cognitive rehabilitation therapy services. Providers who typically use these codes include: psychologists, speech language pathologists, occupational therapists, physicians in rehabilitative medicine, neurologists, psychiatrists, and other related medical specialists.
Code: 97532: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct patient contact by the provider, each 15 minutes. Clinicians often use this code for cognitive rehabilitation when working with neurologically impaired clients. When using this code, it is best to attach a recommendation from a referring physician that specifically recommends cognitive rehabilitation.
Code: 97533: Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environment demands, direct patient contact by the provider, each 15 minutes.
Code: 90834: Psychotherapy, 45 minutes. This CPT code can be used when health care professionals integrate cognitive rehabilitation into a cognitive behavioral psychotherapy intervention directed to help the client improve insight, gain better emotional control, develop coping skills and to learn to modify or change their behavior when faced with challenges or deficits. In this treatment paradigm, cognitive rehabilitation interventions (CRI) are implemented interactively by the therapist with the client as part of a comprehensive treatment plan. Typically, these interventions are included in order to help improve psychotherapy treatment goals that focus on improving frustration tolerance, developing better response inhibition, increasing processing speed, enhancing sustained attention, increasing self-awareness, developing better self-control, increasing positive attitudes, improving emotional self-regulation and learning how to apply problem solving strategies, etc. The therapy notes will need to document the goals and purpose of the inclusion of CRI interventions in respect to the billing for psychotherapy services. Providers may also need to directly contact insurance companies in order to clarify patient qualifications and other requirements or restrictions pertaining to the inclusion of CRI interventions when billing for these types of clinical services.