Insurance coverage varies according to insurance company and state, but all major carriers now cover Cognitive Rehabilitation. It is billed in 15 minute units with fees paid at $35 to $55 per unit, depending on the region of the country. A treatment plan is required and progress must be documented. In addition, the patient needs to be qualified to show that he or she can possibly benefit from this form of treatment. Currently, neurological disorders, strokes, cancer treatment (medicines used to treat cancer are toxic to the brain) and traumatic brain injuries are covered. Alzheimer’s is usually not covered. It is recommended that a prescription for cognitive rehabilitation be obtained from the treating physician and that the clinician also call the insurance company involved if there are specific concerns regarding the client’s policy.
These are multidisciplinary codes that can be used by any healthcare professional qualified to provide cognitive rehabilitation therapy services. Providers who typically use these codes include: psychologists, speech language pathologists, occupational therapists, physicians in rehabilitative medicine, neurologists, psychiatrists, and other related medical specialists.
Code: 97532: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct patient contact by the provider, each 15 minutes.
Code: 97533: Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environment demands, direct patient contact by the provider, each 15 minutes.