There are several timed CPT codes, especially in the section Physical Medicine and Rehabilitation. Timed CPT codes refers to that the procedure or service must last for a certain period defined by the CPT code. The therapeutic procedures and constant attendance modalities are 15 minutes per 1 unit. Adhering to 15 minutes per unit may not be possible for various reasons. CMS address this with the 8-minute rule.
What is difference between a time-based code versus other CPT codes?
Time-based codes have a specific time as part of the definition of the code. The documentation of time is a required element for the code to be billed to for reimbursement. Depending on the amount of time spent on performing the procedure determines the number of units to bill in conjunction to the CPT code.
Service CPT codes do not have the time as a required element, and a single unit can only be reported per service CPT code. An example of a service code is 97164 “re-evaluation of physical therapy established plan of care…”. The therapist can perform the evaluation for 3 minutes or 30 minutes, and it would not change the number of units billed for this code.
What is the 8-minute rule?
CMS states that a timed procedure must be performed for at least 8 minutes to qualify for one unit.
How does the rule work?
The total time spent performing a procedure is divided by 15 minutes; equals the number of units billed. If the remainder time is more than 8 minutes, then an additional unit can be billed.
For instance, if 24 minutes was spent on manual therapy techniques (CPT 97140), 24 divided 15 equals 1.6 units. The remainder time is 9 minutes (greater than 8 minutes and therefore another unit) meaning 24 minutes is equal to 2 units here. Check out the CMS chart below for an easier method to convert actual time to units.
CMS published a chart to calculate the number of units per CPT code more manageable:
How does that affect documentation?
Therapists should document (in the medical record) the actual amount of time performing a timed procedure and/or modality. By documenting the actual time in the medical record performing a procedure versus documenting units takes away any doubt of the number of units billed. Medicare requires documentation of the actual time in the medical record for compliance.
Time is tied to CPT reporting of codes for certain physical therapy procedures and/or modalities. Understanding the 8-minute rule allows the therapist to better report the CPT codes performed for accuracy of records and compensation.
Reference: CMS- 8 minute rule
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Email: claire@q1stmdb.com
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