Thursday, October 14, 2010

Reporting of service units - cms 1500 - 24G Days or Units field CMS 1450 - FL 46

Enter the appropriate number of units billed on the claim line for the service date.

For Consecutive Days of Service:

Enter the total number of days or units within the billing period.

For Nonconsecutive Dates of Service:

Enter “1” for each date of service or unit entered on the claim form.

For Anesthesia:

Enter the total number of 15-minute periods, including as one unit any remaining fraction that equals or exceeds five minutes, that make up the beginning and ending clock time for the anesthesia service.
See 130 CMR 433.000 for regulations about reporting anesthesia time. If no units are entered, the service is paid at the base rate.

Reporting of Service Units

The definition of service units (FL 46 on the Form CMS-1450) where HCPCS code reporting is required is the number of times the service or procedure being reported was performed.


If the following codes are performed once on a specific date of service, the entry in the service units field is as follows:

HCPCS Code              Service Units

90849 - Multiple-family group psychotherapy

Units > 1

92265 - Needle oculoelectromyography, one or more extraocular muscles, one or both eyes, with interpretation and report

Units > 1

95004 - Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, specify number of tests.

Units = no. of tests performed

95861 - Needle electromyography two extremities with or without related paraspinal areas

Units > 1

6 Units > 83 min. to < 98 min.
7 Units > 98 min. to < 113 min.
8 Units > 113 min. to < 128 min.

The pattern remains the same for treatment times in excess of two hours. Hospitals should not bill for services performed for less than eight minutes. The expectation (based on the work values for these codes) is that a provider’s time for each unit will average 15 minutes in length. If hospitals have a practice of billing less than 15 minutes for a unit, their A/B MAC (A) will highlight these situations for review.

The above schedule of times is intended to provide assistance in rounding time into 15-minute increments. It does not imply that any minute until the eighth should be excluded from the total count as the timing of active treatment counted includes time.

The beginning and ending time of the treatment should be recorded in the patient’s medical record along with the note describing the treatment. (The total length of the treatment to the minute could be recorded instead.) If more than one CPT code is billed during a calendar day, then the total number of units that can be billed is constrained by the total treatment time. For example, if 24 minutes of code 97112 and 23 minutes of code 97110 were furnished, then the total treatment time was 47 minutes; so only 3 units can be billed for the treatment. The correct coding is two units of code 97112 and one unit of code 97110, assigning more units to the service that took more time.

 Clarification of HCPCS Code to Revenue Code Reporting

Generally, CMS does not instruct hospitals on the assignment of HCPCS codes to revenue codes for services provided under OPPS since hospitals’ assignment of cost vary. Where explicit instructions are not provided, providers should report their charges under the revenue code that will result in the charges being assigned to the same cost center to which the cost of those services are assigned in the cost report.

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