Caregiver Training Services
What are Caregiver Training Services (CTS)?
The Centers for Medicare & Medicaid Services (CMS) began reimbursing for Caregiver Training Services (CTS) on January 1, 2024. CTS provides payment to practitioners for training to one or more of a Traditional Medicare patient's caregivers to help the patient with their treatment plan. Medicare will cover CTS if the patient requires a caregiver to support their treatment and the caregiver's training supports the patient's treatment plan. Caregiver training may include instruction on how to:
- Give medications
- Help with daily tasks
- Move the patient safely
- Communicate effectively with the patient
- Understand the patient's medical condition(s)
- Provide emotional support
- Give personalized care
The patient or their representative must consent for their caregiver to receive training services, and practitioners must document consent in the patient's medical record. Note that CTS services are subject to the usual Medicare Part B cost sharing requirement. CMS recommends practitioners notify the patient about cost sharing in advance of the service.
The patient does not need to be present for the caregiver to receive training services. The practitioner can provide training services to one or more caregivers per Medicare patient.
How is “caregiver” defined?
CMS defines a caregiver as “an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation” and “a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.”
Why provide CTS?
Caregivers play important roles in helping patients manage their conditions, but many caregivers do not have healthcare backgrounds nor do they receive formal training for being a caregiver. CTS support both caregivers and patients in following treatment plans. CTS also provides payment to practitioners for the time given to educate the patient's caregiver, even if the patient is not present.
Who can provide CTS?
CTS can be provided by a:
- Physician
- Nurse Practitioner
- Physician Assistant
- Clinical nurse specialist
- Certified nurse-midwife
- Clinical psychologist
- Therapist, including physical therapist, occupational therapist, and speech-language pathologist
Clinical social workers, marriage and family therapists, and mental health counselors can bill Medicare for services related to the diagnosis and treatment of mental health conditions, including substance use disorder. Clinical social workers, marriage and family therapists, and mental health counselors can provide and bill for medically necessary CTS to support patients in carrying out their treatment plans for mental health conditions.
What are the billing codes for CTS?
There are five CPT codes for face-to-face CTS. There are no limits to how often CTS can be billed, but instances should be medically necessary. CTS cannot be provided by telehealth.
Two codes focus on behavior management/modification in a group setting. Specifically, these codes are for multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s):
- 96202: Multiple-family group behavior management/modification training for caregiver(s) of patients with a mental or physical health diagnosis; initial 60 minutes
- 96203: Multiple-family group behavior management/modification training for caregiver(s) of patients with a mental or physical health diagnosis; each additional 15 minutes (List separately in addition to code for primary service)
Note, there is currently no code for behavior management/modification for training for the caregiver(s) of a single patient.
Three CPT codes focus on face-to-face caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (for example, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present):
- 97550: Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community; initial 30 minutes
- 97551: Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community; each additional 15 minutes (List separately in addition to code for primary service) (Use 97551 in conjunction with 97550)
- 97552: Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community with multiple sets of caregivers
The group code (97552) should be used to bill when multiple caregivers are trained at the same time for more than one patient. The individual codes (97550 and 97551) should be used to for CTS services provided to one or more caregivers for a single patient; practitioners should not bill these codes for each caregiver if there is more than one caregiver in a single training session.
How do I document CTS in my electronic health record (EHR)?
The practitioner should document the need for each CTS session in the patient's medical record. The practitioner should also document the patient or their representative's consent.
Resources
- Care Management, Centers for Medicare & Medicaid Services
- Health Equity Services in the 2024 Physician Fee Schedule Final Rule, Centers for Medicare & Medicaid Services
- Health-Related Social Needs FAQ, Centers for Medicare & Medicaid Services
Last Updated: 11/26/2024
Last Reviewed: 11/26/2024