In the ever-evolving landscape of health care, the recent update on caregiver training services (CTS) brings forth a wave of excitement and innovation. The Centers for Medicare & Medicaid Services (CMS) Calendar Year 2024 Medicare Physician Fee Schedule Final Rule introduced new billable codes that signify a pivotal step towards recognizing and supporting caregivers in their crucial roles. Let’s explore the details of these new codes, their guidelines, and the potential impact they can have on patient care.

New Billable Codes

The update introduces three new billable codes, each catering to different aspects of caregiver training:

  • 97550 - Caregiver training first 30 minutes (minimum 16 minutes).
  • 97551 - Caregiver training each additional 15 minutes (minimum 8 additional minutes).
  • 97552 - Group caregiver training (minimum of 2 patients represented, no maximum).

IMPORTANT NOTE: Code selection is based on the number of patients represented, NOT the number of caregivers.

Understand the Guidelines

Here are eight insights to empower you to navigate the landscape of caregiver support with confidence and expertise.

  1. Defining a Caregiver: CMS defines a caregiver as, “An adult member or another 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” or “A family member, friend, or neighbor who provides unpaid assistance for a person with a chronic illness or disabling condition.”
  2. Non-Diagnostic Specific: CTS is not diagnostic-specific and may be applied across settings and patient populations, highlighting its focus on equitable access to medically necessary services.
  3. Exclusion of Telehealth: These services cannot be performed via telehealth at this time, yet advocacy efforts are ongoing.
  4. Consent Requirements: Consent from the patient and/or their legal representative must be documented in the medical record allowing patient representative(s) to receive caregiver training without the patient present.
  5. Inclusion in the Plan of Care: CTS must be included in the plan of care, aligning with the desired clinical outcome and ensuring a coordinated, comprehensive approach to patient care.
  6. Patient Absence and Medical Necessity Documentation: The reasons for the patient's absence during CTS services must be documented for each applicable session, as lack of patient availability may not support medical necessity.
  7. Treatment Plan Alignment: The volume and frequency of CTS must align with the treatment plan, ensuring that caregiver training is integrated seamlessly into the overall care strategy. The impact of CTS on resident goals including caregiver response should be documented thoroughly.
  8. Payor Specifications: While the code is available for use with all payors and patient populations, currently only Medicare has approved reimbursement for CTS using these new codes. This limitation underscores the need for continued advocacy and collaboration within the health care community.
  9. Medicare Part A: While Medicare has approved reimbursement for CTS minutes delivered under 97550, 97551 and 97552 cannot be included on the MDS. Refer to the MDS 3.0 RAI Manual v1.18.11 Section O0400 for coding guidance.

For more help on coding CTS, view this helpful flowchart.

Kristi SmithKelly CooneyThe introduction of new billable codes for caregiver training services marks a significant step towards recognizing and supporting the vital role of caregivers in the development and implementation of treatment plans across diverse health care settings. In alignment with the pursuance of health equity, the industry can anticipate a positive shift in patient care, promoting a holistic and collaborative approach to well-being. As we embrace these changes, we set the stage for a future where caregiving is not only recognized but also integrated seamlessly into the fabric of compassionate and comprehensive health care.

Kristi Smith serves as senior vice president of clinical strategies and consulting at HealthPRO Heritage where she utilizes her passion for health care, resident advocacy, and payment reform to guide strategies for success. Kelly Cooney serves as the senior vice president of regulatory and compliance at HealthPRO Heritage with a focus on risk mitigation and compliance policy and procedures internally and for HealthPRO partners.