Community-Based Therapy Services for TBI Patients: Essential CPT Codes and Billing Standards

By Bruce W. McCollum, Long-Term Care Project Manager

Livonia, MI – In community-based settings, Traumatic Brain Injury (TBI) patients benefit significantly from comprehensive, non-traditional therapies that address physical, mental, and emotional health. Services like recreational therapy, massage therapy, personal training/fitness, and dietician services offer essential support for recovery and quality of life improvements. For these services, healthcare providers use specific CPT codes that govern billing, ensure standardized definitions, and establish clear guidelines for execution. Here, I will outline each service, its associated CPT code, billing increments, and current average rates in the Midwest.

1. Recreational Therapy

CPT Code: 97110 – Therapeutic Exercises
Definition and Execution: Recreational therapy employs therapeutic exercises and activities that aim to rebuild motor and cognitive functions while boosting emotional health. This therapy includes adaptive sports, art, music, or structured leisure activities that target improvement in physical coordination, cognitive skills, and social engagement. Each session is customized to the TBI patient’s functional goals and capacity, with the therapist guiding exercises designed to enhance recovery and foster enjoyment in everyday activities.

Billing Increments: CPT Code 97110 is billed in 15-minute increments.
Average Rate in the Midwest: $30–$40 per 15-minute session.

2. Massage TherapyCPT Code: 97124 – Therapeutic Procedure, Massage, Including Effleurage, Petrissage, and/or Tapotement
Definition and Execution: Massage therapy uses soft tissue manipulation to alleviate pain, reduce muscle stiffness, enhance relaxation, and improve blood flow. Techniques such as effleurage (long strokes), petrissage (kneading), and tapotement (rhythmic tapping) are common, each aimed at specific therapeutic goals. Massage therapy is especially beneficial for TBI patients who suffer from muscular tension, headaches, or stress, and can be adapted to suit each individual’s tolerance and response to treatment.

Billing Increments: CPT Code 97124 is billed in 15-minute increments.
Average Rate in the Midwest: $25–$35 per 15-minute session.

3. Personal Training/Fitness

CPT Code: 97150 – Therapeutic Procedure, Group (two or more individuals)
Definition and Execution: Personal Training or Fitness Therapy, when utilized for therapeutic purposes, is designed to improve physical strength, flexibility, coordination, and overall fitness, which are often compromised in TBI patients. Personal training sessions focus on structured exercise routines, including strength training, balance exercises, and cardiovascular activities, adapted to the specific health needs of TBI patients. Certified trainers work in conjunction with licensed therapists to ensure the fitness program aligns with rehabilitation goals, especially when conducted in a group setting to foster social interaction and motivation.

Billing Increments: CPT Code 97150 is billed per 15-minute unit.
Average Rate in the Midwest: $20–$30 per 15-minute session.

4. Dietician Services

CPT Codes:

97802 – Medical Nutrition Therapy; Initial Assessment and Intervention, Individual, Face-to-Face, Each 15 Minutes
97803 – Medical Nutrition Therapy; Reassessment and Intervention, Individual, Face-to-Face, Each 15 Minutes

Definition and Execution: Dietician services in a community-based setting are critical for TBI patients, as diet can significantly influence cognitive function and physical health. Dieticians provide Medical Nutrition Therapy (MNT), evaluating the patient’s nutritional needs, creating personalized meal plans, and offering guidance on dietary modifications that support recovery and optimize health outcomes. Regular follow-ups allow dieticians to assess the patient’s progress and adjust nutritional interventions as needed.

Billing Increments: Both codes (97802 and 97803) are billed in 15-minute increments.

Average Rate in the Midwest: $25–$45 per 15-minute session.

Implementation and Execution Guidelines:

Each of these therapeutic services for TBI patients must be provided by qualified professionals with the relevant certifications or licensure, ensuring that they understand the unique needs of brain-injured individuals. Here’s how these services should be carried out to meet therapeutic goals:

Recreational Therapy should be dynamic, incorporating patient-preferred activities where possible, and designed to stimulate both motor and cognitive skills.
Massage Therapy should be customized to each patient’s specific muscular tension and pain areas, as well as their tolerance to touch. Techniques must be chosen to support relaxation and physical comfort without over-stimulation.
Personal Training/Fitness should prioritize safe, adaptive exercises that enhance strength, balance, and flexibility. Certified trainers should carefully monitor TBI patients’ responses to prevent fatigue or injury and to encourage gradual improvements in fitness.
Dietician Services should be flexible, adjusting to any TBI-related dietary restrictions, swallowing issues, or unique nutritional needs. Sessions include ongoing assessments to ensure that dietary plans remain supportive of the patient’s evolving health status.

Billing and Documentation Standards:

Accurate billing and thorough documentation are essential for compliance and reimbursement in community-based settings. Each service must be documented with a focus on:

Medical necessity – outlining why each therapy is appropriate and necessary for the patient’s rehabilitation.
Progress notes – detailing each session’s outcomes and patient responses to measure the effectiveness of the therapy.
Service specifics – capturing the exact minutes billed, specific techniques used, and any patient feedback or adjustments made during the session.

My Wrap-Up for You…

The provision of community-based therapies, including recreational therapy, massage therapy, personal training/fitness, and dietician services, offers valuable benefits to TBI patients, fostering improved recovery, comfort, and overall quality of life. By using the appropriate CPT codes and maintaining high documentation standards, providers can deliver and receive fair reimbursement for these essential services.

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