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Outpatient Occupational and Physical Therapy Services Billing Guide
- Introduction to Outpatient OT and PT Services
- Outpatient Occupational and Physical Therapy Coverage
- Caregiver Training Services
- KX Modifier Threshold
- 2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring
- Annual Update to the Therapy Code List
- Targeted Medical Review
- Functional Reporting - Using the G Codes
- What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy
- Maintenance Programs
- Multiple Procedure Payment Reduction
- The National Correct Coding Initiative
- Comprehensive Error Rate Testing Program
- Recovery Auditor
- Common Billing Errors and Remittance Message
- Medical Review Therapy Documentation Checklist for Additional Development Request Letters
- Common Questions and Answers
- Related Content
- Related Articles
Counting Units for Therapy Codes
Counting units for therapy services can be complicated; therefore, we are providing guidance. First, you must understand the difference between timed codes and untimed codes in order to determine how to correctly bill units.
Timed Codes
Several CPT codes used for therapy modalities, procedures, and tests and measurements specify direct (one-on-one) time spent with the patient is 15 minutes. Report procedure codes for services delivered on any single calendar day using CPT codes and the appropriate number of 15-minute units of service. Services provided for a single timed CPT code less than eight minutes should not be billed.
Report the CPT code for the time actually spent in the delivery of the modality requiring constant attendance and therapy services. Pre- and post-delivery services are not to be counted in determining the treatment service time. The time counted is the time the patient is treated.
When more than one service represented by 15-minute timed codes is performed in a single day, the total number of minutes of service determines the number of timed units billed.
The chart below provides time intervals for billing units based on treatment time in minutes.
| Units | Number of Minutes |
|---|---|
| 1 | ≥ 8 minutes-22 minutes |
| 2 | ≥ 23 minutes-37 minutes |
| 3 | ≥ 38 minutes-52 minutes |
| 4 | ≥ 53 minutes-67 minutes |
| 5 | ≥ 68 minutes-82 minutes |
| 6 | ≥ 83 minutes-97 minutes |
| 7 | ≥ 98 minutes-112 minutes |
| 8 | ≥ 113 minutes-127 minutes |
Examples
The following examples illustrate how to count the appropriate number of units for the total therapy minutes provided.
Example 1
- 24 minutes of neuromuscular reeducation, 97112
- 23 minutes of therapeutic exercise, 97110
- 47 minutes total treatment time
The 47 total treatment time falls within the range for three units (see chart).
Each service was performed for more than 15 minutes and should be billed for at least one unit, but the total allows three units. In this instance, report two units of 97112 and one unit of 97110, assigning more timed units to the service that took the most time.
Example 2
- 20 minutes of neuromuscular reeducation, 97112
- 20 minutes therapeutic exercise, 97110
- 40 minutes total treatment time
The 40 total treatment time falls within the range for three units (see chart).
Each service was performed for at least 15 minutes and should be billed for at least one unit, but the total allows three units. Since the time for each service is the same, choose either code for two units and bill the other for one unit. Do not bill three units for either one of the codes.
Example 3
- 33 minutes of therapeutic exercise, 97110
- 7 minutes of manual therapy, 97140
- 40 minutes total treatment time
The 40 total treatment time falls within the range for three units (see chart).
In this instance, you would bill two units of 97110 and one unit of 97140. You count the first 30 minutes of 97110 as two full units. Then, compare the remaining time for 97110 (33-30=3 minutes) to the time spent on 97140 (7 minutes) and bill the larger, which is 97140.
Example 4
- 18 minutes of therapeutic exercise, 97110
- 13 minutes of manual therapy, 97140
- 10 minutes of gait training, 97116
- 8 minutes of ultrasound, 97035
- 49 minutes total treatment time
The 49 total treatment time falls within the range for three units (see chart).
Bill the procedures you spent the most time providing. Bill one unit for 97110, 97116 and 97140. You may not bill for the ultrasound (97035) because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill four units for less than 53 minutes regardless of how many services were performed). You would still document the ultrasound in the treatment notes.
Untimed Codes
The units for untimed codes are reported based on the number of times the procedure is performed, as described in the HCPCS code definition (often once per day). When reporting service units for codes where the procedure is not defined by a specific timeframe (untimed codes), a "1" is entered in the units field.
Note: The units for untimed codes are based upon the number of times the procedure is performed regardless of the number of minutes spent.
The following are examples of untimed codes:
- Evaluations/re-evaluations (97161-97168)
- Group therapy (97150)
- Supervised modalities (97012)
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Reviewed 10/07/2024