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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Counting Units for Therapy Codes

8-Minute Rule

Several Current Procedural Terminology (CPT) codes used for therapy modalities, procedures, and tests and measurements specify that direct (one-on-one) time spent with the patient is fifteen (15) minutes. Report procedure codes for services delivered on any single calendar day using CPT codes and the appropriate number of fifteen (15) minute units of service. Services provided for a single timed CPT code that is less than eight (8) minutes should not be billed.  

Report the CPT code for the time actually spent in the delivery of the modality requiring constant attendance and therapy services. Pre- and post-delivery services are not to be counted in determining the treatment service time. The time counted is the time the patient is treated.

When more than one service represented by fifteen (15) minute timed codes is performed in a single day, the total number of minutes of service determines the number of timed units billed.

The chart below provides time intervals for billing units based on treatment time in minutes.

Units

Number of Minutes

1

= 8 minutes through 22 minutes

2

= 23 minutes through 37 minutes

3

= 38 minutes through 52 minutes

4

= 53 minutes through 67 minutes

5

= 68 minutes through 82 minutes

6

= 83 minutes through 97 minutes

7

= 98 minutes through 112 minutes

8

= 113 minutes through 127 minutes

Examples

Example 1

  • Twenty-four (24) minutes of neuromuscular reeducation, 97112
  • Twenty-three (23) minutes of therapeutic exercise, 97110
  • Forty-seven (47) minutes total treatment time

The forty-seven (47) total treatment time falls within the range for three (3) units (see chart).

Each service was performed for more than fifteen (15) minutes and should be billed for at least one (1) unit, but the total allows three (3) units. In this instance, report two (2) units of 97112 and one (1) unit of 97110, assigning more timed units to the service that took the most time.

Example 2

  • Twenty (20) minutes of neuromuscular reeducation, 97112
  • 20 minutes therapeutic exercise, 97110
  • 40 minutes total treatment time

The forty (40) total treatment time falls within the range for three (3) units (see chart).

Each service was performed for at least fifteen (15) minutes and should be billed for at least one (1) unit, but the total allows three (3) units. Since the time for each service is the same, choose either code for two (2) units and bill the other for one (1) unit. Do not bill three (3) units for either one of the codes.

Example 3

  • Thirty-three (33) minutes of therapeutic exercise, 97110
  • Seven (7) minutes of manual therapy, 97140
  • Forty (40) minutes total treatment time

The forty (40) total treatment time falls within the range for three (3) units (see chart).

In this instance, you would bill two (2) units of 97110 and one (1) unit of 97140. You count the first thirty (30) minutes of 97110 as two (2) full units. Then, compare the remaining time for 97110 (33-30=3 minutes) to the time spent on 97140 (7 minutes) and bill the larger, which is 97140.

Example 4

  • Eighteen (18) minutes of therapeutic exercise, 97110
  • Thirteen (13) minutes of manual therapy, 97140
  • Ten (10) minutes of gait training, 97116
  • Eight (8) minutes of ultrasound, 97035
  • Forty-nine (49) minutes total treatment time

The forty-nine (49) total treatment time falls within the range for three (3) units (see chart).

Bill the procedures you spent the most time providing. Bill one (1) unit for 97110, 97116, and 97140. You may not bill for the ultrasound (97035) because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill four (4) units for less than fifty-three (53) minutes regardless of how many services were performed). You would still document the ultrasound in the treatment notes.

Example 5

  • Seven (7) minutes of neuromuscular reeducation (97112)
  • Seven (7) minutes therapeutic exercise (97110)
  • Seven (7) minutes manual therapy (97140)
  • Twenty-one (21) Total timed minutes

Appropriate billing is for one unit. The qualified professional shall select one appropriate CPT code (97112, 97110, 97140) to bill since each unit was performed for the same amount of time and only one unit is allowed.

NOTE: The above schedule of times is intended to provide assistance in rounding time into fifteen (15) minute increments. It does not imply that any minute until the eighth should be excluded from the total count. The total minutes of active treatment counted for all fifteen (15) minute timed codes includes all direct treatment time for the timed codes. Total treatment minutes - including minutes spent providing services represented by untimed codes - are also documented.

Untimed Codes

The units for untimed codes are reported based on the number of times the procedure is performed, as described in the healthcare common procedure coding system (HCPCS) code definition (often once per day). When reporting service units for codes where the procedure is not defined by a specific timeframe (untimed codes), a 1 is entered in the units field.

Note: The units for untimed codes are based upon the number of times the procedure is performed regardless of the number of minutes spent.

The following are examples of untimed codes:

  • Evaluations/Re-evaluations (97161-97168)
  • Group therapy (97150)
  • Supervised modalities (97012)

Determining What Time Counts Towards 15-Minute Timed Codes - All Claims

Providers report the code for the time actually spent in the delivery of the modality requiring constant attendance and therapy services. Pre- and post-delivery services are not to be counted in determining the treatment service time. In other words, the time counted as “intra-service care” begins when the therapist or physician (or an assistant under the supervision of a physician or therapist) is directly working with the patient to deliver treatment services. The patient should already be in the treatment area (e.g., on the treatment table or mat or in the gym) and prepared to begin treatment.

The time counted is the time the patient is treated. For example, if gait training in a patient with a recent stroke requires both a therapist and an assistant, or even two therapists, to manage in the parallel bars, each fifteen (15) minutes the patient is being treated can count as only one unit of code 97116. The time the patient spends not being treated because of the need for toileting or resting should not be billed. In addition, the time spent waiting to use a piece of equipment or for other treatment to begin is not considered treatment time.


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