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Written by: Darlene D'Altorio-Jones (1959-2015) on Monday, June 18, 2012 Posted in: Outpatient Rehab

I was recently asked how you can bill for any code when you provide that service for less than seven minutes.  If staff believe seven minutes of service can never be billed, then there is education that must be shared so that services rendered are accounted for and billed appropriately. In the Medicare Claims Processing Manual, 100-04, Chapter 5 – 20.2, Medicare has outlined three different scenarios for when and why you drop a bill for a code that is provided for seven minutes in conjunction with other codes on the same day

It is correct that if only one service is provided and it is a timed service with the length of treatment less than eight minutes; that you may not bill for the seven minutes. The scenarios in the examples provided by Medicare below will help staff to understand when it is acceptable to drop a coded charge for services less than eight minutes. It is up to the discretion of the therapist to select when there are equal opportunities to choose a CPT code – even when only seven minutes is provided.

This particular section of the Claims Processing Manual is good to print and discuss often with staff. Their ability to bill correctly is linked to their understanding of the concepts presented when dropping charges for services rendered to Medicare beneficiaries. These are the examples Medicare provides:

-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 units billed. If any 15 minute timed service that is performed for seven minutes or less than seven minutes on the same day as another 15 minute timed service that was also performed for seven minutes or less and the total time of the two is eight minutes or greater than eight minutes, then bill one unit for the service performed for the most minutes. This is correct because the total time is greater than the minimum time for one unit

-If seven minutes of neuromuscular reeducation (97112), seven minutes therapeutic exercise (97110), seven minutes manual therapy (97140) for 21 Total timed minutes is provided. Appropriate billing is for one unit. The qualified professional shall select one appropriate CPT code (97112, 97110, 97140) to bill since each unit was performed for the same amount of time and only one unit is allowed.

-If there are 33 minutes of therapeutic exercise (97110), and seven minutes of manual therapy (97140), for a total of 40 Total timed minutes. The following is how to determine appropriate billing for the 40 minutes or three units of service. Bill two units of 97110 and one unit of 97140. Count the first 30 minutes of 97110 as two full units. Compare the remaining time for 97110 (33-30 = three minutes) to the time spent on 97140 (seven minutes) and bill the larger, which is 97140.