Caregiver coding for Georgia Medicaid billing

Update: as of 07/2025 we have yet to see any of these codes be paid by a CMO provider for Georgia. Medicaid does recognize the codes, however make sure you have an authorization

The new codes: 97550, 97551, 97552 are caregiver codes that are new in 2024 and recently were added starting on 4/1/2024 quarterly manual on GAMMIS. These are codes you can use to help parents/guardians as caregivers for your patients. 

There are guidelines on your national board websites as to what the definition is for each code, but here's a generic description as all therapies can use it (taken from ASHA's site):

97550	Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes
97551	Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; 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 (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers

I had a few questions as to the limits of these codes based on Medicaid's guidelines for Georgia. I reached out to the director of CIS and here's her response: 

I assume these units are combined with the 8 units allowed per month already? Yes, these procedures are included in the 8 units per month.

Does authorization need to be obtained if exceeded combined codes are used in conjunction with other cpts during a month? Yes

Are these codes considered part of "family of coding" pertaining to authorizations? No

Can another therapist see caregivers for training while therapy is being performed by another therapist with the patient at the same scheduled time? Currently, I have not seen any guidance that prohibits this scenario.

https://www.asha.org/practice/reimbursement/coding/new_codes_slp/

https://www.medbridge.com/blog/2024/01/new-caregiver-training-cpt-codes-for-pt-ot-slp-a-care-and-reimbursement-opportunity/#:~:text=97550%20%E2%80%93%20Caregiver%20training%20in%20strategies,safety%20practices)%20(without%20the%20patient

Here are the current rates for each code: 

97550 = $44.05

97551 = $21.86

97552 = $18.55

So each code is 1 unit. I have tested Medicaid only on these codes and you can bill the code on the same day as other therapies. For example: 

OT:

97530 4 units

97550 1 unit

As most of you know, usually you can't bill more than 5 units per day, but this coding does work. 

If anyone has any other info, please pass that info along to us as well.