When can I bill which code? What’s the Difference?

97127 G0515 97127 G0515

Medicare Fee-for-Service Untimed 15-Minute Units

x Medicare
Fee-for-Service only
recognizes G0515. x
Medicare Advantage Plans

x
Medicare Part C should 97127 is a service-based code, which means you Just like the “old” cognitive intervention code,
recognize G0515, but should only bill 1 unit for the service provided  G0515 should be billed in 15-minute units,
make sure to check with regardless of the face-to-face time. following the 8-minute rule.
your plan.

Commercial Plans Expands theemphasis to more Emphasis is on a ttention, memory,and

cognitive areas problem solving
Check with your plan. Check with your plan.
 any commercial plans
M Some commercial plans
willlikely accept 97127. may accept only G0515.

Medicaid
Check with your plan.
Check with your plan to
Some plans may accept
see if t hey accept 97127.
only G0515.
97127 focuses on executive function, reasoning, pragmatic
G0515 is limited to the development of cognitive skills to
functioning, and the use of compensatory strategies for
improve attention, memory, and problem solving.
managing the performance of activities.

CPT® Code HCPCS Code

AS OF JANUARY 1, 2018,
97532 HAS BEEN
DELETED AND SHOULD 97127 is a Current Procedural Terminology code and is
G0515 is a Health Care Procedure Coding System

NOT BE BILLED.
(HCPCS) code and is created by the Centers for
published in the 2018 CPT Book
Medicare & Medicaid Services (CMS).
There are two new
cognitive intervention codes Billing
that started January 1, 2018:
Cognitive
1 97127  Intervention
Therapeutic interventions that focus on
cognitive function (e.g., attention, memory, for Occupational
reasoning, executive function, problem
solving, and/or pragmatic functioning) and
compensatory strategies to manage the
performance of an activity (e.g., managing
Therapy
time or schedules, initiating, organizing
and sequencing tasks), direct (one-on-
one) patient contact.
2 G0515
Development of cognitive skills to improve
attention, memory, problem-solving
(includes compensatory training), direct
(one-on-one) patient contact, each 15
minutes.
For more information visit
www.aota.org/cpt