Do you handle physical therapy billing every day? Are you confused about timed vs untimed codes? Studies show 45% of PT claims get denied for timing errors. Wrong time calculations cost practices $85,000 yearly on average. About 70% of PT billing errors involve time-based codes. The 8-minute rule confuses 60% of billing staff members. Proper time documentation can reduce denials by 75% easily.
Physical therapy uses both timed and untimed CPT codes. Timed codes bill based on time spent with the patient. Untimed codes bill per session regardless of time. Medicare’s 8-minute rule controls timed code billing requirements. Research shows 50% of practices miscalculate billable units regularly. Many therapists lose 15-25% revenue from timing mistakes alone. Understanding code differences prevents costly claim denials and audits.
This guide explains timed and untimed codes in simple terms. We show how to calculate billable units correctly. Learn the 8-minute rule and when to apply it. Improve your practice revenue with accurate time tracking today. These guidelines work for all physical therapy practice sizes. Follow these rules to get paid correctly every time.
Understanding Timed CPT Codes
Timed codes bill based on minutes spent with the patient. Each code has specific time requirements for billing.
What Are Timed Codes
Timed codes need specific treatment time documentation. Bill in 15-minute unit increments only. Common timed codes include therapeutic exercises and activities. Manual therapy and neuromuscular reeducation are timed, too. Gait training codes also bill by time. Document exact start and stop times always.
Common Timed Code Examples
Code 97110 covers therapeutic exercises for patients. Code 97112 is neuromuscular reeducation therapy. Code 97140 covers the manual therapy techniques used. Code 97530 is therapeutic activities training. Code 97116 covers gait training with the patient. Each code bills per 15-minute unit.
Time Documentation Requirements
Document the exact minutes spent on each service. Record start and stop times for activities. Only count direct patient contact time. Cannot include documentation time in calculations. Break times do not count toward billable. Time must be medically necessary for the patient. Missing time docs cause automatic claim denials.
Understanding Untimed CPT Codes
Untimed codes bill per session regardless of time. These codes do not use the 8-minute rule. Each service is billed once per session only.
What Are Untimed Codes
Untimed codes bill once per treatment session. Time spent does not affect billing units. Common untimed codes include evaluations and re-evaluations. Hot and cold packs are untimed services. Electrical stimulation codes are also untimed, typically. Bill one unit per session performed.
Common Untimed Code Examples
Code 97010 covers hot or cold packs. Code 97014 is electrical stimulation unattended. Code 97035 covers ultrasound therapy treatments. Code 97016 is a vasopneumatic device used. Initial evaluation code 97161 is untimed, too. Re-evaluation code 97164 bills once per session. Group therapy code 97150 is also untimed.
Documentation for Untimed Services
Document service was provided during the session. Note the medical reason for the untimed service. Include patient response to treatment given. Time documentation is not required for untimed codes. Cannot bill the same untimed code twice. Must have a separate session for multiple billings.
The 8-Minute Rule Explained
The 8-minute rule determines billable units allowed. Medicare requires this calculation method for timed codes.
How the 8-Minute Rule Works
Add total minutes for all timed services. Divide total minutes by 15 for units. 8-14 minutes equals one billable unit. 23-37 minutes equals two billable units. 38-52 minutes equals three billable units. Round down if under an 8-minute threshold. Each additional 15 minutes adds one unit.
Calculating Billable Units
Total all timed service minutes together first. Use the chart to determine the total units allowed. Distribute units among services provided appropriately. Bill’s highest value codes first, usually. Cannot exceed the total units calculated from time. Document calculations in billing records always.
Common 8-Minute Rule Mistakes
Billing units without meeting time thresholds required. Counting non-billable time in total calculations. Rounding up instead of down incorrectly. Billing the same code multiple times inappropriately. Not documenting the total time spent clearly. Mixing timed and untimed rules together.
Billing Multiple Services
Multiple services often occur during one session. Proper calculation ensures correct unit billing. Documentation must support all services billed clearly.
Combining Timed Services
Add all timed service minutes together. Calculate total billable units from combined time. Assign units to each service performed. Highest reimbursement codes get units first. Must have 8 minutes minimum per code. Cannot split units between the same codes. Document the time for each service separately.
Mixing Timed and Untimed Codes
Bill untimed codes once per session, always. Calculate timed codes usingthe 8-minute rule. Do not include untimed service time. Keep separate documentation for each type. Untimed codes do not affect unit calculations. Can bill both types same session. Review payer policies for specific rules.
Service Combination Rules
Some codes cannot be billed together same day. Check NCCI edits before billing multiple codes. Use modifiers to override edits when appropriate. Document medical necessity for all combinations billed. Insurance companies have bundling rules, too. Review EOBs for bundling and denials.
Documentation Best Practices
Good documentation supports every claim submitted successfully. Time tracking must be accurate and clear. Proper records protect against audits and denials.
Time Tracking Methods
Use a timer to track treatment time accurately. Record start and stop times immediately. Document the time for each service separately. Do not estimate time at the end. Keep a running time log during treatment. Review time totals before calculating units. Accurate tracking prevents billing errors completely.
Required Documentation Elements
Include patient name and date of service. List all services provided during the session. Document the time for timed services clearly. Note medical necessity for all treatments. Include patient response to each intervention. Sign and date all treatment notes. Missing elements lead to claim denials.
Avoiding Documentation Errors
Complete notes immediately after each session. Do not use generic templates only. Include specific patient details and progress. Review notes for completeness before billing. Train staff on documentation requirements regularly. Conduct random chart audits monthly for quality. Good docs prevent most billing problems.
Common Billing Errors to Avoid
PT billing has many potential error sources. Understanding common mistakes helps prevent them quickly. Most errors result from time calculations.
Time Calculation Mistakes
Not tracking time accurately during treatment sessions. Estimating time instead of recording actual minutes. Including non-billable time in total calculations incorrectly. Rounding up when should round down. Billing more units than the time supports. Not using the 8-minute rule correctly always.
Code Selection Errors
Using timed code when untimed is appropriate instead. Billing the wrong CPT code for the service provided. Not checking code descriptors before billing claims. Using outdated codes from previous years. Billing duplicate codes for the same service. Missing required modifiers on certain codes.
Unit Calculation Problems
Billing maximum units without time support. Not calculating the total time before assigning units. Distributing units incorrectly among the services provided. Exceeding allowable units per day limits. Not documenting unit calculations in records. Billing fractional units is not allowed. Software checks catch many unit errors.
Conclusion
Understanding timed vs untimed codes is essential for PT billing. Timed codes need 8-minute rule calculations for units. Untimed codes bill once per session only. Proper time tracking and documentation prevent most denials. Calculate billable units correctly using total time. Common mistakes include time tracking and calculation errors. Following these guidelines improves billing accuracy and revenue.
FAQs
What is the difference between timed and untimed codes?
Timed codes bill based on minutes spent with the patient. They use 15-minute unit increments for billing. Untimed codes bill once per session regardless.
How does the 8-minute rule work?
Add all timed service minutes together first. Divide the total by 15 to get units. 8-14 minutes equals one billable unit. Each additional 15 minutes adds another unit.
Can I bill timed and untimed codes together?
Yes, you can bill both types same session. Calculate timed codes using the 8-minute rule separately. Bill untimed codes once per session only. Do not mix time calculations together.
How many units can I bill per day?
Medicare allows up to 6 units per day, typically. Some payers have different daily limits, though. Check specific payer policies before billing multiple units. Document medical necessity for all units billed.
What happens if I bill units incorrectly?
Insurance will deny or downcode the claim. You may face audits and recoupment requests. Repeated errors can trigger compliance investigations, too. Correct billing practices prevent these problems completely.
