Time-Based Therapy Billing: How to Calculate Number of Units

Are you utilizing timed codes properly?

There are certain CPT codes used in providing therapy services that are billed based on 15 minute intervals, or units. These services include procedure codes 97032, 97033, 97035, 97110, 97140, 97112, 97116, and 97530.time-430625_640

In order for a provider to bill out 1 unit of these codes, he or she must provide a minimum of 8 minutes of direct patient care. This is called the 8 Minute Rule. But providers often spend much more than this on patients with greater needs of specialized care and attention. In these situations, multiple units can be billed.

See the chart below for a quick guide to how much time is required to support billing multiple units:

8 – 22 minutes 1 unit
23 – 37 minutes 2 units
38 – 52 minutes 3 units
53 – 67 minutes 4 units
68 – 82 minutes 5 units
83 minutes 6 units

According to Medicare guidelines, instances where time spent on multiple services that individually do not equal 8 minutes but together do equal 8, one unit of service can be billed using the higher total time service. This is good to know, but keep in mind that not all payers will follow along in these guidelines.

Always be sure your documentation supports your billing, and be specific regarding time spent providing services. Many payers will request medical notes to support time based billing.

So make the most of your time and remember, if it isn’t documented, it didn’t happen!

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