Surgical · General

Therapeutic procedures performed simultaneously for a group of two or more patients under skilled therapist supervision.

Verified May 8, 2026 · 8 sources ↓

Medicare: $18.04
Total RVUs: 0.54
Global, days
Region: General

Drawn from CMSAcatodayProactivechartHealthnetworksolutionsSprypt

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Identify the specific treatment techniques used in the group session by name.
State clinical rationale explaining how each technique addresses each patient's functional deficit.
Record the number of patients in the group and confirm minimum two participants.
Document each patient's individual response: participation level, cues required, measurable progress or tolerance.
Note therapist involvement throughout — skilled supervision must be continuous, not intermittent check-ins only.
Link session activities to individualized treatment goals in each patient's plan of care.
Record total session time even though 97150 is untimed; supports medical necessity and audit defense.
Specify therapy-type modifier rationale (GP, GO, GN) consistent with the supervising clinician's discipline.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

52 Reduced services 59 Distinct service XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

97150 covers supervised group therapeutic sessions where two or more patients receive skilled therapy at the same time. Patients do not need to perform identical activities — the defining feature is that a licensed therapist (PT, OT, chiropractor) is supervising the group, providing skilled intervention, cues, and modifications rather than extended one-on-one contact with a single patient.

97150 is an untimed, per-session code. Bill it once per patient per visit regardless of session length. Do not stack units and do not report the underlying individual therapy code (e.g., 97110) alongside it for the same session — per AMA guidance, 97150 replaces those codes when work is performed in a group setting. NCCI edits bundle 97150 with PT/OT evaluation codes billed on the same date; modifier 59 is required to unbundle when the group session is genuinely distinct.

Medicare requires therapy-type modifiers: GP for physical therapy plan of care, GO for occupational therapy, GN for speech-language pathology. When a PTA or OTA delivers part of the group session, append CQ or CO accordingly. Same-day individual therapy codes billed alongside 97150 also require modifier 59 to survive NCCI edits — and the documentation must show distinct timeframes and separate therapeutic intent for each service.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.29
Practice expense RVU	0.24
Malpractice RVU	0.01
Total RVU	0.54
Medicare national rate	$18.04
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$18.04

Common denial reasons

The recurring reasons claims for CPT 97150 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

No individualized patient response documented — group notes that describe only the activity without per-patient outcomes.
97150 billed as a timed code with multiple units per session, which contradicts its untimed, once-per-visit structure.
Individual therapy code (e.g., 97110) billed same-day without modifier 59, triggering NCCI bundling and payment reduction to the lower-value group code.
Missing or wrong therapy-type modifier (GP, GO, GN) required by Medicare and most payers.
Medical necessity not established — documentation shows patients exercising independently without skilled therapist intervention.
97150 billed same-day as a PT or OT evaluation without modifier 59 to bypass the NCCI edit effective 1/1/2020.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Is 97150 a timed code billed per 15-minute unit?

No. 97150 is untimed. Bill it once per patient per session regardless of how long the group runs. Stacking units is a billing error and a common audit flag.

02Can I bill 97110 and 97150 together on the same day?

Yes, but only if the individual and group sessions are genuinely separate encounters with distinct therapeutic intent and documented different timeframes. Append modifier 59 to the individual code. Without it, NCCI edits will bundle the services and pay only the lower group therapy rate.

03Do all patients in the group have to be doing the same exercise?

No. Medicare explicitly states patients can perform different activities. What matters is that a skilled therapist is supervising the group and providing individualized interventions, cues, or modifications to each participant.

04What modifier do I need for Medicare claims?

Append the therapy-type modifier matching the plan of care: GP for physical therapy, GO for occupational therapy, GN for speech-language pathology. If a PTA or OTA delivers any portion, also add CQ or CO respectively. Missing these modifiers is a clean-claim failure on Medicare Part B.

05Can 97150 be billed the same day as a PT or OT evaluation?

NCCI edits bundle 97150 with PT/OT evaluation codes when billed on the same date of service. If the group session and evaluation are truly separate and distinct, append modifier 59 to 97150 and document the separate encounters clearly. Many practices avoid same-day billing of both to reduce audit exposure.

06What is the minimum group size to bill 97150?

Two patients. If only one patient is present, the session defaults to individual therapy and the appropriate timed code (e.g., 97110) applies. Document patient count in every group note.

07Can a chiropractor or speech-language pathologist bill 97150?

Chiropractors can bill 97150 under the same rules and should append modifier 59 when billing alongside CMT or E/M codes. Speech-language pathologists should note that CMS NCCI policy excludes them from reporting 97150 — SLPs use 92508 for group speech treatment instead.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the group composition (patient count), each patient's individualized therapeutic activity, therapist supervision actions, cues provided, and objective response per patient — the exact elements auditors look for when 97150 is billed repeatedly. That prevents the most common denial: a group note that describes the class but can't demonstrate skilled, individualized care for each billed patient.

See how Mira captures CPT 97150 documentation