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PT/OT units

  1. #1
    Default PT/OT units
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    Our physical and occupational therapists do their own coding, but I review denials. Most of the information I can find limits the number of units by the total time. They have been billing any services performed for at least 8 minutes. So for example they did 3 different services for 8 minutes each. Under CMS rules that is 24 minutes so we can only bill 2 total units. My providers are billing 3 units unless it is a Medicare/Medicaid/federal plan. When I asked about it, I was given this link:

    I asked around and none of the coders with therapy experience were familiar with the Substantial Portion Methodology (SPM). I can only find references that come back to this one source/author. It appears to be the way things were calculated before the 8-minute rule came about, but this article is from 2017 and says it can be used with any plan that hasn't adopted the CMS rule from 2000.


  2. Default sistersarah
    I am currently in the same boat. I code the Professional side in a hospital setting and we acquired a new PT/OT group that utilizes SPM for calculating units for each therapy procedure. I researched APTA and could not find anything, asked my OHS PT/OT group and they too had never heard of this but these new therapist swore by it. I have requested documentation and specific guidelines that they have to support this and I'm currently waiting for that, this is helpful and I will follow-up here if I have anything to add.

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