Article - Billing and Coding: Outpatient Physical and Occupational Therapy Services (A56566)

Timed CPT CodesMany CPT codes for therapy modalities and procedures specify that direct (one-on-one) time spent in patient contact is 15 minutes.The time counted is the time the patient is treatedusing skilled therapy modalities and procedures, and is recorded in the documentation as Timed Code Treatment Minutes. Pre- and post-delivery services are not to be counted when recording the treatment time. The time counted is the intra-service care that begins when the qualified professional/auxiliary personnel is directly working with the patient to deliver the service. The patient should already be in the treatment area (e.g., on the treatment table or mat or in the gym) and prepared to begin treatment. The intra-service care includes assessment. The time the patient spends not being treated because of a need for toileting or resting should not be counted. In addition, the time spent waiting to use a piece of equipment or for other treatment to begin is not considered treatment time. Time spent supervising a patient performing an activity that is defined as a timed code, or for the patient to perform an independent activity, even if a therapist is providing the equipment, is considered unbillable time and these minutes should not be counted in the Timed Code Treatment Minutes. Therapy timed services require direct, one-on-one patient qualified professional/auxiliary personnel contact, and by definition cannot be billed when performed in a supervised manner.The first step when billing timed CPT codes is to total the minutes for all timed modalities and procedures provided to the patient on a single date of service for a single discipline. For example, a patient under an OT plan of care receives skilled treatment consisting of 20 minutes therapeutic exercise (CPT 97110) and 20 minutes self-care/home management training (CPT 97535). The total Timed Code Treatment Minutes documented will be 40 minutes. In addition, the combined time of 40 minutes will determine the total number of timed code OT units that shall be billed for the day. Whether a single timed code service is provided, or multiple timed code services, the skilled minutes documented in Timed Code Treatment Minutes will determine the number of units billed. Once the minutes have been summed, use the chart below to determine the total allowable units, based on the total Timed Code Treatment minutes.1 unit > 8 minutes through 22 minutes2 units > 23 minutes through 37 minutes3 units > 38 minutes through 52 minutes4 units > 53 minutes through 67 minutes5 units > 68 minutes through 82 minutes6 units > 83 minutes through 97 minutes7 units > 98 minutes through 112 minutes8 units > 113 minutes through 127 minutesWhen the total Timed Code Treatment minutes for the day is less than 8 minutes, the service(s) should not be billed. It is important to allocate the total billable units for timed services to the appropriate CPT codes based upon the number of minutes spent providing each individual service. Any timed service provided for at least 15 minutes, must be billed one unit. Any timed service provided for at least 30 minutes, must be billed two units, and so on. When determining the allocation of units, it is easiest to separate out each service first into 15-minute time blocks. For example: 20 minutes of Therapeutic Exercise (CPT 97110) = one 15-minute block + 5 remaining minutesAt least 1 unit must be allocated to this code38 minutes of Self-care/Home Management Training (97535) = two 15-minute blocks + 8 remaining minutesAt least 2 units must be allocated to this codeIf 38 minutes of CPT 97535 is the only treatment provided, then 3 units would be billed. However, as demonstrated in the examples below, there may be treatment sessions in which the correct billing would only allow 2 units, based on the remaining minutes.The remaining minutes (those minutes remaining after the 15-minute blocks have been allocated) are considered when the total billable units for the day allow for an additional unit to be billed. See the following examples: