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Cognitive Rehabilitation

Section: Therapy
Effective Date: January 01, 2020
Revised Date: December 31, 2019

Description

Cognitive rehabilitation describes therapeutic activities designed to improve cognitive function and retrain an individual's ability to think, use judgment and make decisions.The focus of these therapeutic activities is to improve deficits in memory, attention, perception, visual processing, language, reasoning, learning, planning, judgment, and problem-solving.

Criteria

Cognitive rehabilitation, as a distinct and definable component of the rehabilitation process, may be considered medically necessary for the rehabilitation of traumatic and acquired braininjury including but not limited to brain hemorrhage, cerebral thrombosis, concussion, fractured skull and post-traumaticencephalopathy, and anoxic brain damage.

Cognitive rehabilitation may be considered medically necessary for individuals who are able to interactively participate in the therapy and are expected to make significant cognitive improvement and ALL of the following:

  • The services must be ordered by the attending physician and be part of a written plan of care; and
  • The service is so complex that it can only be performed by a qualified licensed professional; and
  • The individual is capable of actively participating in the program and capable, by mental status, of demonstrating responsiveness to verbal or visual stimuli and able to follow commands and process and retain information; and
  • The individual’s mental and physical condition prior to the injury indicates there is significant potential for improvement (e.g., a complete recovery of pre-injury memory, language or reasoning skills is not required, but there must be a reasonable expectation of improvement that is of practical value to the individual, measured against the individual’s condition at the start of the rehabilitation program), and the individual must have no lasting or major treatment impediment that prevents progress, such as severe dementia; and
  • The individual is expected to show measurable functional improvement within a predetermined timeframe (depending on the underlying diagnosis or medical condition) from the start of cognitive rehabilitation therapy. Goals and expected timeframes can be addressed before the onset of treatment; and
  • The attending physician must review the treatment plan periodically to assess the continued need for participation and document objective evidence of the individuals progress; and
  • Neuropsychological testing has been performed and neuropsychological results will be used in treatment-planning and redirecting rehabilitation strategies.

Cognitive rehabilitation provided for any other condition will be denied as experimental/investigational and, therefore, non-covered.The safety and effectiveness of this service cannot be established by review of the available published peer-reviewed literature.

A maintenance therapy program includes activities that maintain theindividual’s present level of function and prevent regression of that function. Maintenance begins when the therapeutic goals of a treatment plan have been achieved or when no further functional progress is apparent or expected to occur. Maintenance therapy is not an eligible service.

Procedure Codes

97129 97130

Diagnosis Codes

F07.0

F07.9

F07.81

F07.89

F09

F44.4

F48.2

G92

G93.1

G93.40

G93.41

I60.2

I60.4

I60.6

I60.7

I60.8

I60.9

I60.00

I60.01

I60.02

I60.10

I60.11

I60.12

I60.30

I60.31

I60.32

I60.50

I60.51

I60.52

I61.0

I61.1

I61.2

I61.3

I61.4

I61.5

I61.6

I61.8

I61.9

I62.1

I62.9

I62.00

I62.01

I62.02

I62.03

I63.6

I63.8

I63.9

I63.00

I63.02

I63.09

I63.10

I63.12

I63.19

I63.20

I63.22

I63.29

I63.30

I63.39

I63.40

I63.49

I63.50

I63.59

I63.011

I63.012

I63.013

I63.019

I63.031

I63.032

I63.033

I63.039

I63.111

I63.112

I63.113

I63.119

I63.131

I63.132

I63.133

I63.139

I63.211

I63.212

I63.213

I63.219

I63.231

I63.232

I63.233

I63.239

I63.311

I63.312

I63.313

I63.319

I63.321

I63.322

I63.323

I63.329

I63.331

I63.332

I63.333

I63.339

I63.341

I63.342

I63.343

I63.349

I63.411

I63.412

I63.413

I63.419

I63.421

I63.422

I63.423

I63.429

I63.431

I63.432

I63.433

I63.439

I63.441

I63.442

I63.443

I63.449

I63.511

I63.512

I63.513

I63.519

I63.521

I63.522

I63.523

I63.529

I63.531

I63.532

I63.533

I63.539

I63.541

I63.542

I63.543

I63.549

I65.1

I65.8

I65.9

I65.01

I65.02

I65.03

I65.09

I65.21

I65.22

I65.23

I65.29

I66.3

I66.8

I66.9

I66.01

I66.02

I66.03

I66.09

I66.11

I66.12

I66.13

I66.19

I66.21

I66.22

I66.23

I66.29

I69.010

I69.011

I69.012

I69.013

I69.014

I69.015

I69.018

I69.019

I69.020

I69.021

I69.022

I69.023

I69.028

I69.110

I69.111

I69.112

I69.113

I69.114

I69.115

I69.118

I69.119

I69.120

I69.121

I69.122

I69.123

I69.128

I69.210

I69.211

I69.212

I69.213

I69.214

I69.215

I69.218

I69.219

I69.220

I69.221

I69.222

I69.223

I69.228

I69.310

I69.311

I69.312

I69.313

I69.314

I69.315

I69.318

I69.319

I69.320

I69.321

I69.322

I69.323

I69.328

I69.810

I69.811

I69.812

I69.813

I69.814

I69.815

I69.818

I69.819

I69.820

I69.821

I69.822

I69.823

I69.828

I69.910

I69.911

I69.912

I69.913

I69.914

I69.915

I69.918

I69.919

I69.920

I69.921

I69.922

I69.923

I69.928

S01.90XA

S01.90XD

S01.90XS

S02.0XXA

S02.0XXB

S02.0XXD

S02.0XXG

S02.0XXK

S02.0XXS

S02.11AA

S02.11AB

S02.11AD

S02.11AG

S02.11AK

S02.11AS

S02.11BA

S02.11BB

S02.11BD

S02.11BG

S02.11BK

S02.11BS

S02.11CA

S02.11CB

S02.11CD

S02.11CG

S02.11CK

S02.11CS

S02.11DA

S02.11DB

S02.11DD

S02.11DG

S02.11DK

S02.11DS

S02.11EA

S02.11EB

S02.11ED

S02.11EG

S02.11EK

S02.11ES

S02.11FA

S02.11FB

S02.11FD

S02.11FG

S02.11FK

S02.11FS

S02.11GA

S02.11GB

S02.11GD

S02.11GG

S02.11GK

S02.11GS

S02.11HA

S02.11HB

S02.11HD

S02.11HG

S02.11HK

S02.11HS

S02.19XA

S02.19XB

S02.19XD

S02.19XG

S02.19XK

S02.19XS

S02.91XA

S02.91XB

S02.91XD

S02.91XG

S02.91XK

S02.91XS

S02.92XA

S02.92XB

S02.92XD

S02.92XG

S02.92XK

S02.92XS

S02.101A

S02.101B

S02.101D

S02.101G

S02.101K

S02.101S

S02.102A

S02.102B

S02.102D

S02.102G

S02.102K

S02.102S

S02.109A

S02.109B

S02.109D

S02.109G

S02.109K

S02.109S

S02.110A

S02.110B

S02.110D

S02.110G

S02.110K

S02.110S

S02.111A

S02.111B

S02.111D

S02.111G

S02.111K

S02.111S

S02.112A

S02.112B

S02.112D

S02.112G

S02.112K

S02.112S

S02.113A

S02.113B

S02.113D

S02.113G

S02.113K

S02.113S

S02.118A

S02.118B

S02.118D

S02.118G

S02.118K

S02.118S

S02.119A

S02.119B

S02.119D

S02.119G

S02.119K

S02.119S

S06.0X0A

S06.0X0D

S06.0X0S

S06.0X1A

S06.0X1D

S06.0X1S

S06.0X9A

S06.0X9D

S06.1X0A

S06.1X0D

S06.1X0S

S06.1X1A

S06.1X1D

S06.1X1S

S06.1X2A

S06.1X2D

S06.1X2S

S06.1X3A

S06.1X3D

S06.1X3S

S06.1X4A

S06.1X4D

S06.1X4S

S06.1X5A

S06.1X5D

S06.1X5S

S06.1X6A

S06.1X6D

S06.1X6S

S06.1X7A

S06.1X7D

S06.1X7S

S06.1X8A

S06.1X8D

S06.1X8S

S06.1X9A

S06.1X9D

S06.1X9S

S06.2X0A

S06.2X0D

S06.2X0S

S06.2X1A

S06.2X1D

S06.2X1S

S06.2X2A

S06.2X2D

S06.2X2S

S06.2X3A

S06.2X3D

S06.2X3S

S06.2X4A

S06.2X4D

S06.2X4S

S06.2X5A

S06.2X5D

S06.2X5S

S06.2X6A

S06.2X6D

S06.2X6S

S06.2X7A

S06.2X7D

S06.2X7S

S06.2X8A

S06.2X8D

S06.2X8S

S06.2X9A

S06.2X9D

S06.2X9S

S06.4X0A

S06.4X0D

S06.4X0S

S06.4X1A

S06.4X1D

S06.4X1S

S06.4X2A

S06.4X2D

S06.4X2S

S06.4X3A

S06.4X3D

S06.4X3S

S06.4X4A

S06.4X4D

S06.4X4S

S06.4X5A

S06.4X5D

S06.4X5S

S06.4X6A

S06.4X6D

S06.4X6S

S06.4X7A

S06.4X7D

S06.4X7S

S06.4X8A

S06.4X8D

S06.4X8S

S06.4X9A

S06.4X9D

S06.4X9S

S06.5X0A

S06.5X0D

S06.5X0S

S06.5X1A

S06.5X1D

S06.5X1S

S06.5X2A

S06.5X2D

S06.5X2S

S06.5X3A

S06.5X3D

S06.5X3S

S06.5X4A

S06.5X4D

S06.5X4S

S06.5X5A

S06.5X5D

S06.5X5S

S06.5X6A

S06.5X6D

S06.5X6S

S06.5X7A

S06.5X7D

S06.5X7S

S06.5X8A

S06.5X8D

S06.5X8S

S06.5X9A

S06.5X9D

S06.5X9S

S06.6X0A

S06.6X0D

S06.6X0S

S06.6X1A

S06.6X1D

S06.6X1S

S06.6X2A

S06.6X2D

S06.6X2S

S06.6X3A

S06.6X3D

S06.6X3S

S06.6X4A

S06.6X4D

S06.6X4S

S06.6X5A

S06.6X5D

S06.6X5S

S06.6X6A

S06.6X6D

S06.6X6S

S06.6X7A

S06.6X7D

S06.6X7S

S06.6X8A

S06.6X8D

S06.6X8S

S06.6X9A

S06.6X9D

S06.6X9S

S06.9X0A

S06.9X0D

S06.9X0S

S06.9X1A

S06.9X1D

S06.9X1S

S06.9X2A

S06.9X2D

S06.9X2S

S06.9X3A

S06.9X3D

S06.9X3S

S06.9X4A

S06.9X4D

S06.9X4S

S06.9X5A

S06.9X5D

S06.9X5S

S06.9X6A

S06.9X6D

S06.9X6S

S06.9X7A

S06.9X7D

S06.9X7S

S06.9X8A

S06.9X8D

S06.9X8S

S06.9X9A

S06.9X9D

S06.9X9S

S06.300A

S06.300D

S06.300S

S06.301A

S06.301D

S06.301S

S06.302A

S06.302D

S06.302S

S06.303A

S06.303D

S06.303S

S06.304A

S06.304D

S06.304S

S06.305A

S06.305D

S06.305S

S06.306A

S06.306D

S06.306S

S06.307A

S06.307D

S06.307S

S06.308A

S06.308D

S06.308S

S06.309A

S06.309D

S06.309S

S06.310A

S06.310D

S06.310S

S06.311A

S06.311D

S06.311S

S06.312A

S06.312D

S06.312S

S06.313A

S06.313D

S06.313S

S06.314A

S06.314D

S06.314S

S06.315A

S06.315D

S06.315S

S06.316A

S06.316D

S06.316S

S06.317A

S06.317D

S06.317S

S06.318A

S06.318D

S06.318S

S06.319A

S06.319D

S06.319S

S06.320A

S06.320D

S06.320S

S06.321A

S06.321D

S06.322A

S06.322D

S06.322S

S06.323A

S06.323D

S06.323S

S06.324A

S06.324D

S06.324S

S06.325A

S06.325D

S06.325S

S06.326A

S06.326D

S06.326S

S06.327A

S06.327D

S06.327S

S06.328A

S06.328D

S06.328S

S06.329A

S06.329D

S06.329S

S06.330A

S06.330D

S06.330S

S06.331A

S06.331D

S06.331S

S06.332A

S06.332D

S06.332S

S06.333A

S06.333D

S06.333S

S06.334A

S06.334D

S06.334S

S06.335A

S06.335D

S06.335S

S06.336A

S06.336D

S06.336S

S06.337A

S06.337D

S06.337S

S06.338A

S06.338D

S06.338S

S06.339A

S06.339D

S06.339S

S06.340A

S06.340D

S06.340S

S06.341A

S06.341D

S06.342A

S06.342D

S06.342S

S06.343A

S06.343D

S06.343S

S06.344A

S06.344D

S06.344S

S06.345A

S06.345D

S06.345S

S06.346A

S06.346D

S06.346S

S06.347A

S06.347D

S06.347S

S06.348A

S06.348D

S06.348S

S06.349A

S06.349D

S06.349S

S06.350A

S06.350D

S06.350S

S06.351A

S06.351D

S06.351S

S06.352A

S06.352D

S06.352S

S06.353A

S06.353D

S06.353S

S06.354A

S06.354D

S06.354S

S06.355A

S06.355D

S06.355S

S06.356A

S06.356D

S06.356S

S06.357A

S06.357D

S06.357S

S06.358A

S06.358D

S06.358S

S06.359A

S06.359D

S06.359S

S06.360A

S06.360D

S06.360S

S06.361A

S06.361D

S06.361S

S06.362A

S06.362D

S06.362S

S06.363A

S06.363D

S06.363S

S06.364A

S06.364D

S06.364S

S06.365A

S06.365D

S06.365S

S06.366A

S06.366D

S06.366S

S06.367A

S06.367D

S06.367S

S06.368A

S06.368D

S06.368S

S06.369A

S06.369D

S06.369S

S06.810A

S06.810D

S06.810S

S06.811A

S06.811D

S06.811S

S06.812A

S06.812D

S06.812S

S06.813A

S06.813D

S06.813S

S06.814A

S06.814D

S06.814S

S06.815A

S06.815D

S06.815S

S06.816A

S06.816D

S06.816S

S06.817A

S06.817D

S06.817S

S06.818A

S06.818D

S06.818S

S06.819A

S06.819D

S06.819S

S06.820A

S06.820D

S06.820S

S06.821A

S06.821D

S06.821S

S06.822A

S06.822D

S06.822S

S06.823A

S06.823D

S06.823S

S06.824A

S06.824D

S06.824S

S06.825A

S06.825D

S06.825S

S06.826A

S06.826D

S06.826S

S06.827A

S06.827D

S06.827S

S06.828A

S06.828D

S06.828S

S06.829A

S06.829D

S06.829S

S06.890A

S06.890D

S06.890S

S06.891A

S06.891D

S06.891S

S06.892A

S06.892D

S06.892S

S06.893A

S06.893D

S06.893S

S06.894A

S06.894D

S06.894S

S06.895A

S06.895D

S06.895S

S06.896A

S06.896D

S06.896S

S06.897A

S06.897D

S06.897S

S06.898A

S06.898D

S06.898S

S06.899A

S06.899D

S06.899S

T75.1XXA

T75.1XXD

T75.1XXS

         

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