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Old 05-03-2012, 08:04 AM
paulabjohnson paulabjohnson is offline
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Question Non-medicare time unit billing

There has been much discussion at work regarding how to bill PT/OT timed codes. The CPT manual states that in order to charge for a unit, you must be half-way into the unit. So, for the standard 15 minute increments, 23 minutes need to be completed to charge for a second unit.

However, the hospital we are associated with and the billers that have been here for awhile don't follow that. They say 16 minutes is two units. We understand Medicare billing, it's the rest we are unsure of. Does anyone have information/documentation regarding NON-medicare billing and time units?
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Old 05-03-2012, 02:20 PM
akcpccpbcpma akcpccpbcpma is offline
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I have worked on both the billing end and the payer end (for worker's comp and for the VA) in a number of specialties. As a claim auditor, I never run into a payer who does not follow the 7/8 rule (7 minutes code down, 8 minutes code up) for a 15-minute code. I have had one individual at one payer indicate that each unit had to be a full 15 minutes for them to pay. I have never run into a situation where any payer would allow a unit for 1 minute! I'd suggest you stick with the CPT guidelines, as you have been.

Karen Hill, CPC, CPMA
DHCM
Anchorage, AK
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Old 05-03-2012, 02:27 PM
jmcpolin jmcpolin is offline
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Time Based Codes


8 units > 113 minutes through < 127 minutes
7 units > 98 minutes through < 112 minutes
6 units > 83 minutes through < 97 minutes
5 units > 68 minutes through < 82 minutes
4 units > 53 minutes through < 67 minutes
3 units > 38 minutes through < 52 minutes
2 units > 23 minutes through < 37 minutes
1 unit > 8 minutes through 22 minutes
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Jenifer McPolin CPC, CPMA, RCC
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Old 05-05-2012, 02:00 PM
paulabjohnson paulabjohnson is offline
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Default Any documentation beyond the one paragraph in CPT?

Thank you for the responses. We are attempting to change the rest of the gang but are getting resistance. Is the only documentation the one paragraph on time in the CPT book? I'm not sure what they are looking for from us to prove our point but any help is appreciated.
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