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billing 96101

  1. #1
    Question billing 96101
    Medical Coding Books
    How would you bill if 2.2 hours for this service? Our billing system will not show 2.2 Units but does reflect the money for 2.2 Units. I am reading the description for this and it states per hour so the doctor worked for 2.2 hours. So I am wondering if this should be billed as only 2 Units with prolonged Service code also or 3 Units with modifier for reduces services seeing as it was over 2 hours but not quite 3. Any help would be appreciated. Thanks
    Mona Lisa CPC
    MonaLisa LaBonte CPC

  2. #2
    You would only bill 2 units.

    Over 1/2 the time specified by the code needs to be done in order to bill one unit of the code. It isn't broken down into less than one unit. If they had spent 2 hours and at least 31 minutes, they could bill 3 units. The code, or an additional unit, isn't billed if 30 minutes or less was done.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

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