97535

🏠 CPT 97535 — Self-Care/Home Management Training, Direct One-on-One Contact, Each 15 Minutes

Quick Reference

wRVU: 0.45 | Global Period: XXX (Global concept does not apply — timed therapeutic service) | Assistant Payable: ✅ Yes (with appropriate supervision modifier) | Bilateral Indicator: 0

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📋 Clinical Description

CPT 97535 describes a direct, one-on-one therapeutic training service in which a qualified healthcare professional — most commonly an occupational therapist, physical therapist, or speech-language pathologist — instructs a patient in the skills and compensatory strategies needed to perform self-care and home management tasks safely and independently. The code captures a wide range of training activities including ADLs (bathing, dressing, grooming, toileting, eating), meal preparation, household management, safety procedures, energy conservation techniques, joint protection strategies, and the use of assistive technology devices or adaptive equipment. It is distinct from 97530 (Therapeutic Activities) and 97112 (Neuromuscular Re-education) in that 97535 is specifically focused on real-life functional task performance in the home context rather than exercise-based or neuromotor retraining.

Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) represent the foundational tasks that allow individuals to live independently; when injury, surgery, neurological event, or progressive disease disrupts performance of these tasks, skilled therapeutic instruction — not merely supervised practice — is required to restore safe, independent function. When cognitive decline, neurological damage, or orthopedic changes prevent return to prior ADL independence, the primary diagnosis driving medical necessity is the underlying condition (e.g., I69.351 for post-stroke hemiplegia), not the functional limitation alone.

This procedure may be performed in the following clinical contexts:

• Post-Stroke or Neurological Rehabilitation — Patients with hemiplegia or motor/cognitive deficits following CVA (I69.351, I69.354) require compensatory one-handed techniques and adaptive equipment training to safely resume grooming, dressing, and meal preparation tasks.
• Post-Orthopedic Surgery / Joint Arthroplasty — Patients following total hip or knee arthroplasty (Z96.641) require training in movement precautions (e.g., hip precautions ≤ 90° flexion, no internal rotation) applied directly to ADL task performance such as lower-body dressing and bathing transfers.
• Progressive Neurological Disease — Patients with multiple sclerosis (G35.D) or Parkinson’s disease benefit from energy conservation techniques, task sequencing, and home safety instruction to maintain independence as disease progresses.
• Traumatic Brain Injury or Cognitive Impairment — Patients with TBI or dementia (F02.811) require structured ADL retraining incorporating assistive technology for memory support, routine establishment, and cueing strategies.
• Deconditioning or Reduced Mobility — Patients with generalized deconditioning following hospitalization or prolonged illness (Z74.09) may require skilled ADL training to safely re-establish home management routines with appropriate assistive devices before discharge.

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🔬 Anatomical & Procedural Considerations

Training Domain	Clinical Content	Coding/Documentation Impact
ADL Training (Basic Self-Care)	Direct instruction in bathing, dressing, grooming, toileting, and eating using compensatory strategies or adaptive equipment	Document specific tasks practiced, type of assistance provided (verbal cuing, physical assist), and patient response; must link directly to treatment plan goals
IADL / Home Management Training	Meal preparation, household tasks (cleaning, laundry), financial management, community re-entry tasks	Must document the IADL being trained, why skilled instruction is required, and measurable functional improvement or barrier
Safety Procedures & Precaution Training	Surgical precautions (hip, spinal), fall prevention, transfer safety, emergency procedures at home	Document precautions by name (e.g., “total hip arthroplasty precautions”), specific violations to avoid, and patient demonstration of understanding
Adaptive Equipment / Assistive Technology	Instruction in use of dressing sticks, sock aids, long-handled reachers, shower chairs, grab bars, memory apps, electronic aids	Document each device used, the reason it was prescribed, training steps, and patient’s level of proficiency at session end
Energy Conservation / Joint Protection	Pacing strategies, rest breaks, modified techniques to reduce fatigue or joint stress during home tasks	Document the underlying condition driving the need (e.g., MS-related fatigue, RA joint protection) and the specific strategies taught

Clinical Pearl

CPT 97535 requires skilled, hands-on instruction — passive observation or repeat practice of previously mastered techniques does not meet medical necessity. Documentation must explicitly state why a licensed therapist’s clinical judgment was required to deliver this service, what specific instruction was provided, how long it took (timed to the minute to support the 8-minute rule), and whether the patient demonstrated understanding or return demonstration. Vague documentation such as “ADL training performed” without specificity of the task, technique, adaptive strategy, and patient response is the leading cause of claim denial and post-payment audit recoupment for this code.

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✅ Procedure Includes

• Pre-session clinical assessment of patient’s current functional performance level and barriers to ADL independence
• Direct one-on-one contact with the patient throughout the timed session — concurrent or group sessions do not qualify
• Skilled instruction in specific self-care or home management tasks with defined compensatory techniques or adaptive strategies
• Hands-on demonstration by the therapist and patient return demonstration or supervised practice
• Caregiver/family instruction, when clinically necessary, to support carryover of trained techniques at home
• Documentation of the specific task(s) trained, techniques used, time spent, and the patient’s measurable response or progress toward independence

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❌ Excludes / Do Not Report Together

Code	Description	Relationship to 97535
97530	Therapeutic Activities, direct (one-on-one) patient contact, each 15 minutes	Captures dynamic functional activities designed to improve functional performance (strength, coordination, balance); use when the focus is exercise-based task performance, not ADL instruction or home management training — do not bill simultaneously for the same time block
97112	Neuromuscular Re-education, each 15 minutes	Addresses movement, balance, coordination, kinesthetic sense, and posture through neuro-motor interventions; if a patient is practicing walking or movement patterns, use 97112 not 97535 — these codes should not overlap in time
97110	Therapeutic Exercises, each 15 minutes	Exercise-based code for strengthening, ROM, flexibility, and endurance; home exercise program instruction that is exercise-focused bills under 97110, not 97535
97129 / 97130	Therapeutic Interventions for Cognitive Function	If the primary focus is cognitive strategy training (attention, memory, executive function) as a standalone intervention, consider these codes; 97535 may still apply when cognitive strategy is incorporated into ADL task performance
E/M codes (992xx / 920xx)	Office visit, any level	Separately reportable only when modifier -25 is appended to the E/M code, documenting a significant, separately identifiable E/M service beyond the routine pre-procedure assessment

Bundling Alert — Global Period is XXX (Not Applicable)

CPT 97535 carries a global surgery indicator of XXX, meaning the global surgery concept does not apply to this code — it is a timed therapeutic service, not a surgical procedure. There is no pre- or post-operative period to track. Each session is billed independently based on the time documented for that visit. The most common audit finding is not a global period error, but time documentation failure — the note must clearly record the number of minutes spent on this specific code to support each unit billed under the 8-minute rule. A coder should verify timed service documentation for every unit of 97535 claimed.

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🌳 Code Tree — Medicine: Physical Medicine and Rehabilitation

CPT 97010-97799  Physical Medicine and Rehabilitation
│
├── 97010-97039  Modalities (supervised and constant attendance)
│
├── 97110-97168  Therapeutic Procedures (timed, direct one-on-one)
│   ├── 97110  Therapeutic Exercises, each 15 min
│   ├── 97112  Neuromuscular Re-education, each 15 min
│   ├── 97116  Gait Training, each 15 min
│   ├── 97129  Therapeutic Interventions for Cognitive Function, initial 15 min
│   ├── 97130  Therapeutic Interventions for Cognitive Function, each addl 15 min
│   ├── 97150  Therapeutic Procedures, group (2+ individuals)
│   ├── 97530  Therapeutic Activities, each 15 min
│   ├── ▶▶ 97535 ◀◀  Self-Care/Home Management Training, each 15 min  ← YOU ARE HERE  (Global: XXX)
│   ├── 97537  Community/Work Reintegration Training, each 15 min  (Global: XXX)
│   └── 97542  Wheelchair Management Training, each 15 min  (Global: XXX)
│
└── 97597-97799  Other PM&R Services

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💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	0.45 (verify against current CMS MPFS RVU25A for applicable year)
Global Period	XXX (Global concept does not apply)
Bilateral Indicator	0 — not subject to bilateral reduction rules; this is a whole-body/functional training code
Assistant Surgeon	❌ Not applicable — therapy assistant coverage governed by GP/GO/GN + supervision modifiers
Co-Surgeon	❌ Not applicable
Team Surgery	❌ Not applicable
PC/TC Split	❌ No — procedure code only (Indicator 0)
Modifier -51 Exempt	No — subject to multiple procedure rules when billed with other timed therapy codes
Anesthesia	None — this is a therapeutic training service with no anesthetic component

Therapy Cap & KX Modifier

Medicare therapy caps (now replaced by targeted medical review thresholds) require the -KX modifier when therapy charges for PT/SLP combined or OT alone exceed the annual threshold (~$2,230 in 2025), certifying that services are medically necessary and documentation supports continued treatment. Failure to append -KX when the threshold is exceeded results in automatic claim denial. Verify the current threshold annually from the CMS Therapy Cap Update.

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🏷️ Modifier Reference

Modifier	Name	When to Apply
-GP	Services Delivered Under Outpatient PT Plan of Care	Required by Medicare when a physical therapist or PT assistant bills this code under a PT plan of care
-GO	Services Delivered Under Outpatient OT Plan of Care	Required by Medicare when an occupational therapist or OTA bills this code under an OT plan of care
-GN	Services Delivered Under Outpatient SLP Plan of Care	Required by Medicare when a speech-language pathologist bills under an SLP plan of care
-KX	Requirements Specified in the Medical Policy Have Been Met	Append to 97535 (and all therapy codes on the claim) when Medicare therapy cap threshold is exceeded; attestation that documentation supports medical necessity
-25	Significant, Separately Identifiable E/M	Applied to the E/M code — not 97535 — when an office evaluation is performed on the same date; the E/M must represent a service beyond the routine pre-therapy assessment
-59	Distinct Procedural Service	When 97535 is billed on the same claim as other timed codes and payers are inappropriately bundling; documents separate, non-overlapping time blocks
-52	Reduced Services	Session interrupted or partially completed — document reason and time actually spent
-GA	Waiver of Liability Statement Issued	Required when an Advance Beneficiary Notice (ABN) is on file because service may not be covered by Medicare
-GZ	Item or Service Expected to Be Denied	Used when service is expected to be denied as not reasonable and necessary and no ABN was obtained

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🩺 Common ICD-10-CM Pairings

Post-Stroke / Neurological Impairment

ICD-10 Code	Description	HCC?	Clinical Notes
I69.351	Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side	✅ HCC 103	Most specific code for dominant-side post-stroke motor deficits; document “dominant” vs. “non-dominant” from provider — do not assume; query when absent
I69.352	Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side	✅ HCC 103	Use when left side is documented as non-dominant; confirm handedness in chart
I69.354	Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side	✅ HCC 103	Use when laterality and dominant/non-dominant status are explicitly documented for left-dominant patients
I69.391	Other sequelae of cerebral infarction — use for aphasia, dysphagia, or other non-motor deficits driving ADL training	❌ No	When post-stroke sequelae other than hemiplegia are the primary driver of ADL training (e.g., dysphagia affecting feeding independence)
G35.D	Multiple sclerosis	✅ HCC 77	Use as primary diagnosis when MS-related fatigue, motor dysfunction, or cognitive impairment drives ADL/IADL training needs

Orthopedic / Post-Surgical Rehabilitation

ICD-10 Code	Description	HCC?	Clinical Notes
Z96.641	Presence of right artificial hip joint	❌ No	For post-THA ADL training — document movement precautions in the note; use with aftercare code Z47.1 as appropriate
Z96.642	Presence of left artificial hip joint	❌ No	Left-side THA; same documentation requirements as above
S72.001A	Fracture of unspecified part of neck of right femur, initial encounter	✅ HCC 170	For patients in active fracture treatment requiring ADL and safety training during initial recovery phase
M62.81	Muscle weakness (generalized)	❌ No	When deconditioning-related generalized weakness is the primary driver of ADL training; pair with underlying cause code

Cognitive Impairment / Dementia

ICD-10 Code	Description	HCC?	Clinical Notes
F02.811	Dementia in other diseases classified elsewhere, unspecified severity, with agitation	✅ HCC 52	Code first the underlying disease (e.g., G30.9 Alzheimer’s disease); 97535 supports ADL routine training and use of assistive memory technology
F06.70	Mild neurocognitive disorder due to known physiological condition, without behavioral disturbance	❌ No	For mild cognitive impairment post-TBI or neurological disease; supports training in compensatory strategies for home safety and independence

Deconditioning / Functional Decline

ICD-10 Code	Description	HCC?	Clinical Notes
Z74.09	Other reduced mobility	❌ No	Use only when no more specific underlying condition explains the mobility limitation; commonly over-applied — query for underlying diagnosis before defaulting to this code
R26.89	Other abnormalities of gait and mobility	❌ No	When gait-related ADL barriers (e.g., fall risk affecting home management) are the primary clinical driver

Coding Specificity Reminder

The most common ICD-10-CM specificity gap for 97535 is using Z74.09 when a more specific underlying diagnosis exists (e.g., G35.D, I69.351, M54.5). ICD-10-CM guidelines require you to code the underlying condition to the highest level of specificity supported by documentation — Z74.09 is appropriate only when no specific diagnosis can be identified. When laterality or dominant/non-dominant status is absent from post-stroke documentation, query the provider before defaulting to an unspecified or “non-dominant” assumption. ICD-10-CM specificity requirements are not optional.

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🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder

CPT 97535 is performed primarily in the outpatient/office or home health setting. There are no routine MS-DRG assignments driven by this CPT code. When a patient undergoing an inpatient admission receives ADL training (e.g., during acute rehabilitation or medical/surgical admission), the inpatient facility assigns ICD-10-PCS codes from Section F (Physical Rehabilitation and Diagnostic Audiology), not CPT codes. The ICD-10-PCS code for ADL training will support clinical documentation but will not independently drive DRG grouping — the principal diagnosis and any CCs/MCCs determine DRG tier.

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🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)

Note

ICD-10-PCS Section F (Physical Rehabilitation and Diagnostic Audiology) governs ADL training in the inpatient setting. Root Operation F07 (Activities of Daily Living Treatment) is the appropriate root operation when a therapist is providing instruction or training in ADL performance — not exercise or neuromotor re-education. These codes rarely affect DRG assignment independently but are required for complete inpatient facility coding when documented by the treating therapist.

PCS Code	Full Description	Applicable Modality
F07L0ZZ	Activities of Daily Living Treatment, Whole Body, None, No Device, No Qualifier	Self-care and home management training, general
F07K0ZZ	Activities of Daily Living Treatment, Upper Extremity, None, No Device, No Qualifier	ADL training focused on upper extremity function (dressing, grooming, feeding)
F07J0ZZ	Activities of Daily Living Treatment, Lower Extremity, None, No Device, No Qualifier	ADL training focused on lower extremity function (transfers, bathing, lower-body dressing)

PCS Character Analysis — F07L0ZZ

Position	Character	Value	Definition
1	Section	F	Physical Rehabilitation and Diagnostic Audiology
2	Section Qualifier	0	Rehabilitation
3	Root Type	7	Activities of Daily Living Treatment (exercise or activities to facilitate functional competence for activities of daily living)
4	Body System / Region	L	Whole Body
5	Type Qualifier	0	None (no specific type qualifier)
6	Equipment	Z	None
7	Qualifier	Z	No Qualifier

PCS Root Type: Activities of Daily Living Treatment (7) vs. ADL Assessment (2)

• Use Root Type 7 (Activities of Daily Living Treatment) when a therapist is providing therapeutic training in ADL task performance during the inpatient encounter
• Use Root Type 2 (Activities of Daily Living Assessment) when the therapist is evaluating the patient’s ADL capabilities without therapeutic training intervention
• When both an assessment and treatment occur in the same session, assign separate PCS codes — inpatient PCS coding does not have a modifier equivalent for combined services

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📝 Coding Examples

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Example 1 — Outpatient Clinic: Post-THA ADL Training with Safety Precautions

Clinical Scenario: A 72-year-old female, POD #14 following right total hip arthroplasty, presents to outpatient OT for ADL training. Documentation states: “Patient requires skilled instruction in total hip arthroplasty precautions (no hip flexion >90°, no crossing midline, no internal rotation) as applied to dressing, toilet transfers, and bathing. Adaptive equipment prescribed: long-handled reacher, sock aid, elevated toilet seat. Patient verbally recited precautions and demonstrated return demonstration of lower-body dressing with reacher and sock aid adhering to all precautions. Total direct skilled instruction time: 30 minutes.” No separate E/M was performed.

Field	Code	Rationale
CPT 1	97535-GO x2 units	30 minutes of direct ADL and safety training = 2 units at 15 min/unit; GO modifier required — service delivered under an outpatient OT plan of care
PDx	Z96.641	Presence of right artificial hip joint — aftercare for THA is the reason for the visit
SDx	Z47.1	Aftercare following joint replacement surgery — sequenced as secondary to describe the rehabilitation context

Note

The -GO modifier is required for Medicare billing to identify the service as occupational therapy. Two units of 97535 are supported by 30 minutes of documented direct skilled instruction. No separate E/M is warranted because no distinct evaluation beyond the pre-procedure clinical assessment was performed.

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Example 2 — Outpatient Hospital: Post-Stroke ADL Training, Same-Day Initial OT Evaluation

Clinical Scenario: A 65-year-old male with documented right-dominant hemiplegia following ischemic stroke (onset 3 weeks prior) presents for an initial outpatient OT evaluation and treatment. The therapist performs a formal ADL assessment (billed separately as 97165) and then initiates a 20-minute ADL training session: “Patient trained in one-handed compensatory dressing technique for donning shirt using adaptive method with dominant right hand impaired; instruction in use of button hook and elastic shoelaces; patient required moderate verbal cuing throughout. Total skilled ADL training time: 20 minutes.” Provider documentation clearly supports a separate, distinct evaluation service.

Field	Code	Rationale
CPT 1	97165-GO	Occupational Therapy Evaluation, Low Complexity — initial formal evaluation, separately documented from treatment
CPT 2	97535-GO-59 x1 unit	20 minutes ADL training = 1 unit (8-minute rule met); GO for OT plan of care; -59 distinguishes as a separate, non-overlapping service from the evaluation
PDx	I69.351	Hemiplegia following cerebral infarction, right dominant side — primary driver of functional limitation and medical necessity
SDx	Z74.09	Other reduced mobility — secondary functional status descriptor

Warning

The evaluation (97165) and the treatment (97535) must reflect separate, non-overlapping time blocks in the documentation. Do not apply modifier -25 here — that modifier applies to E/M codes (992xx/920xx), not therapy evaluation codes. If a physician’s E/M were billed on the same date, -25 would go on the E/M.

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Example 3 — Outpatient Clinic: Therapy Cap Threshold Exceeded, KX Modifier Required

Clinical Scenario: A 70-year-old female with multiple sclerosis (G35.D) receiving outpatient OT has accumulated $2,100 in OT charges this calendar year. She presents for continued ADL training focused on energy conservation techniques for morning self-care routine and safe meal preparation. Documentation includes current functional outcome measures (FIM scores), prior level of function, measurable progress toward goals, and clinical justification for continued skilled services. Total ADL training time this session: 30 minutes.

Field	Code	Rationale
CPT 1	97535-GO-KX x2 units	30 minutes ADL training = 2 units; -KX modifier required because OT charges are approaching/exceeding the Medicare therapy threshold; attests that documentation supports continued medical necessity
PDx	G35.D	Multiple sclerosis — primary diagnosis driving the ongoing need for skilled ADL training
SDx	R26.89	Other abnormalities of gait and mobility — secondary functional deficit contributing to ADL limitations

Note

-KX Modifier Reminder: The -KX modifier is an attestation — it certifies that the documentation in the medical record meets the requirements for services above the therapy threshold. It must be appended to every therapy code on every claim line once the threshold is exceeded. Missing -KX results in automatic denial. Document current outcome measures at least every 10 visits (per Medicare CERT requirements) to support continued medical necessity.

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⚠️ Common Coding Pitfalls

• Vague or Non-Skilled Documentation: The most common reason for 97535 denials and post-payment audits is documentation that fails to specify the task, technique, level of assist, and therapist’s skilled role. Entries like “ADL training performed x30 min” without naming the specific activity, the compensatory strategy or adaptive equipment used, why skilled instruction was required (not merely supervised practice), and the patient’s measurable response will not survive audit. The note must read like skilled clinical intervention, not a daily log.

• Billing 97535 for Repeat Practice of Mastered Tasks: Once a patient has achieved modified or full independence with a specific ADL task, repeating the same session does not constitute skilled intervention and is not billable under 97535. Continued billing after the patient has met the documented goal for that task is fraudulent overpayment. Advance the treatment plan goals or discharge that component, and document the skill required for any new training introduced.

• Time Overlap Between Timed Codes: CPT 97535 and other timed codes (97530, 97110, 97112) cannot share the same minutes — they must reflect non-overlapping, distinct time blocks. Billing two timed codes for the same 15-minute window is a false claims exposure. Document start and stop times for each timed code within the session to create an auditable time record.

• Missing Therapy Discipline Modifier (GP/GO/GN): Medicare requires the appropriate discipline modifier (GP for PT, GO for OT, GN for SLP) on every timed therapy claim line. Omitting the modifier causes claim rejection or incorrect routing to the wrong therapy benefit cap. This is a clean-claim requirement, not just a documentation issue.

• Using Z74.09 When a Specific Diagnosis Exists: Defaulting to Z74.09 (Other reduced mobility) when a specific underlying condition (e.g., post-stroke hemiplegia, MS, post-THA aftercare) is documented and supports the medical necessity narrative understates clinical complexity, may not satisfy payer medical necessity criteria, and misses HCC capture opportunities where applicable. Query for specificity before assigning Z74.09.

• Failing to Apply KX Modifier at Cap Threshold: Omitting the -KX modifier once the Medicare therapy threshold has been reached results in automatic claim denial. The coder and billing staff must track cumulative therapy charges per discipline per beneficiary per calendar year and flag the claim for -KX appended to all therapy lines at the threshold crossing point.

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📎 Sources

¹ AMA CPT 2025 Professional Edition — CPT 97535 descriptor, Medicine: Physical Medicine and Rehabilitation section

² CMS 2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F) — Therapy Services, Reimbursement Updates

³ CMS RVU25A Relative Value Files — Work RVU and billing indicator data for CPT 97535

⁴ CMS NCCI Policy Manual, Chapter 11 — Physical Medicine and Rehabilitation Edits, 2024-2025

⁵ ICD-10-CM Official Guidelines for Coding and Reporting FY2025 — Section I.C.21 (Z Codes), Section I.C.18 (Symptoms and Signs)

⁶ ICD-10-PCS Official Guidelines for Coding and Reporting FY2025 — Section F, Physical Rehabilitation and Diagnostic Audiology

⁷ CMS MLN Booklet: Therapy Services — Documentation, Coverage, and Billing Requirements (MLN006558)

⁸ CMS Medicare Benefit Policy Manual, Chapter 15, §§220-230 — Outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services

⁹ WebPT — “How to Correctly Use CPT Code 97535” (2024) — https://www.webpt.com/blog/how-to-use-cpt-code-97535

¹⁰ TheraPlatform — “CPT Code 97535: Occupational Therapy Billing Guide” — https://www.theraplatform.com/blog/943/cpt-code-97535

¹¹ NetHealth — “Impaired Mobility ICD-10 Codes: What You Need to Know” (2025) — Z74.09 usage guidance for rehab therapy

¹² AOTA (American Occupational Therapy Association) — Coding and Payment Guide for OT 2025