Wiki Has anyone heard of Partial Billing Methodology that states only 1 minute of treatment is needed to bill 1 unit of a timed procedure, lets say 15 min?

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arielcosta

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Has anyone heard of Partial Billing Methodology that states only 1 minute of treatment is needed to bill a unit of that procedure?

For example, this methodology would suggest that if a Physical Therapist performs treatment on a patient utilizing Neuromuscular Reeducation (CPT 97112) for a total of 5 minutes, 1 unit can be billed.

97112 is a 15 minute time code. Guidelines state 8 minutes are needed to bill a unit. Billing methodologies are unfamiliar to me; therefore, I'm wondering if anyone has been exposed to this methodology.
 
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arielcosta said:
Has anyone heard of Partial Billing Methodology that states only 1 minute of treatment is needed to bill a unit of that procedure?

For example, this methodology would suggest that if a Physical Therapist performs treatment on a patient utilizing Neuromuscular Reeducation (CPT 97112) for a total of 5 minutes, 1 unit can be billed.

97112 is a 15 minute time code. Guidelines state 8 minutes are needed to bill a unit. Billing methodologies are unfamiliar to me; therefore, I'm wondering if anyone has been exposed to this methodology.
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Are there other services being billed with it on the same date of service?

If they are performing a service for 7 minutes or less on the same date that another service is performed for 7 minutes or less, you can combine the time and bill one unit for the service performed for the most minutes.

If you're providing only one service in a day, you should not bill for services performed less than 8 minutes.

This is direct from the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation:



C. Counting Minutes for Timed Codes in 15 Minute Units
When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes.

(chart not pasted - see the full document at the link above)

If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit for the service performed for the most minutes.

There are some specific examples given in the claims processing manual at the link above. I didn't paste all of the examples, but you can review them in the manual at the link above. It starts on roughly page 40 of the PDF.
 
sls314 said:
Are there other services being billed with it on the same date of service?

If they are performing a service for 7 minutes or less on the same date that another service is performed for 7 minutes or less, you can combine the time and bill one unit for the service performed for the most minutes.

If you're providing only one service in a day, you should not bill for services performed less than 8 minutes.

This is direct from the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation:



C. Counting Minutes for Timed Codes in 15 Minute Units
When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes.

(chart not pasted - see the full document at the link above)

If any 15 minute timed service that is performed for 7 minutes or less than 7 minutes on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two is 8 minutes or greater than 8 minutes, then bill one unit for the service performed for the most minutes.

There are some specific examples given in the claims processing manual at the link above. I didn't paste all of the examples, but you can review them in the manual at the link above. It starts on roughly page 40 of the PDF.
Click to expand...
Correct, CMS follows cumulative time billing methodology. I should have been more expansive in my question, my apologies. There is discussion currently within an organization of there being 3 billing methodologies: 1) would be the CMS "cumulative time" methodology, 2) would be "Substantial Portion" methodology which would be following coding guidelines of needing 8 minutes to bill 1 unit, and 3) is stating to be "Partial" methodology where only 1 minute is needed to bill a unit. I have never heard of this "Partial" billing methodology and so I was curious if anyone else has.
 
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