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If the patient is Non-Medicare...
is the therapeutic exercise 97110 of 16 minutes billable as 2 units?
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Physical or Occupational Therapy Billing Question:

units?"

My Reply: The answer to your question is NO.

Per CPT Guidelines, the Therapeutic Exercise (97110) Therapeutic procedure, 1 or more
areas,
each 15 minutes; therapeutic exercises to develop strength and endurance, range
of motion and flexibility.

So logically, 16 minutes is
not 2 units. It is too far to be even near 2 units.

I think following Medicare's 8-Minute Rule is the best way to count the units. After all, in my
professional opinion, most of the insurance companies follow this guideline. And I think,
your timely and accurate documentation for your services is very important here.

I searched Guidelines from Major Insurance companies, I have not seen any insurance who
has a guideline that shows on how to count the units. But the description of each code is
being described based on what is on the CPT Code Book, such as for example with 97110
Therapeutic procedure, 1 or more areas,
"each 15 minutes"; therapeutic exercises to
develop strength and endurance, range of motion and flexibility.

Let Me Share to you Again the Medicare's 8-minute Rule (plain and simple to follow):

CMS "8" - Minute Rule

1 unit        ≥ 8 minutes through 22 minutes
2 units      ≥ 23 minutes through 37 minutes
3 units      ≥ 38 minutes through 52 minutes
4 units      ≥ 53 minutes through 67 minutes
5 units      ≥ 68 minutes through 82 minutes
6 units      ≥ 83 minutes through 97 minutes
7 units      ≥ 98 minutes through 112 minutes
8 units      ≥ 113 minutes through 127 minutes

*** less than 8 minutes is not billable if only one time-based code is used on the same date
of service or on the same day
*** for one time-based code performed in 15 minutes must be billed as 1 unit from looking
at the rule (8-22 minutes equals 1 unit!)

Let's do the Math:

->Get the total minutes for all time-based therapy codes:

97110 for 32 minutes
97140 for 12 minutes
== TOTAL MINUTES is 44 minutes (go back to the chart, 44 minutes is 3 units!)

BILL 97110 for 2 units and 97140 for 1 unit

Another Example:

97124 for 10 minutes
97110 for 16 minutes
97140 for 29 minutes
== TOTAL MINUTES is 55 minutes (go back to the chart, 55 minutes is 4 units!)

BILL 97140 for 2 units 97110 for 1 unit and 97124 for 1 unit

Please read more on
Physical Therapy Coding and Billing here.


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