Sunday, July 19, 2015

Rehabilitation Therapy Billing Guidelines , calculation of units

Practitioner billing for Part B rehab therapy services on a 1500 claim form or electronic equivalent:
Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that best describe the therapy services rendered

Functional Therapy Reporting ‘G’ codes *

HCPCS/CPT therapy modifiers
GN, services delivered under a SLP plan of care
GO, services delivered under an OT plan of care
GP, services delivered under a PT plan of care
Severity/Complexity Modifiers
CH, 0% impaired, limited or restricted
CI, 1% but less than 20% impaired or restricted
CJ, 20% but less than 40% impaired or restricted
CK, 40% but less than 60% impaired or restricted
CL, 60% but less than 80% impaired or restricted
CM, 80% but less than 100% impaired or restricted
CN, 100% impaired or restricted

Units - Number of times the service/procedure reported according to the HCPCS/CPT code definition
Untimed, bill as 1 unit
Timed, definition includes time; e.g., 15 minutes
Bill as 1 or more units depending on time spent in direct one-on-one contact with the patient
Units are constrained by the total treatment time
Do not bill for less than 8 minutes
Time must be documented in the medical record as either:
total number of timed minutes or;
beginning and ending time
Pre- and post-delivery services are not to be counted towards treatment time
Counting Minutes for Timed Codes

Billable Units Number of Minutes
1 ≥ 8 minutes through 22 minutes
2 ≥ 23 minutes through 37 minutes
3 ≥ 38 minutes through 52 minutes
4 ≥ 53 minutes through 67 minutes
6 ≥ 68 minutes through 82 minutes
7 ≥ 83 minutes through 97 minutes
8 ≥ 98 minutes through 112 minutes
9 ≥ 113 minutes through 127 minutes

Billing Units example
Documentation shows:
7 minutes of neuromuscular reeducation (97112)
7 minutes of therapeutic exercise (97110)
7 minutes of manual therapy (97140)
21 Total timed minutes
Billable codes/units (21 minutes = 1 billable unit)
Select one of the codes to bill
Although only one code is billed, documentation should include all services rendered.

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