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2990Re: Billing question on timed codes

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  • djgeisel
    Mar 5, 2008
    • 0 Attachment
      Thank you. So at least for Medicare, you are saying you must do the
      service for at least 8 min to use a timed code which states first 15
      min. in it's description. And if you attach a 52 modifier that tells
      them that you did the 8 min minimum? Plans that are not specific
      about a minimum time do not require you to at least 8 min. Am I
      understanding that right? Thank you for your help. Diana

      --- In MedicalBillers@yahoogroups.com, B Burgess <granbfly@...> wrote:
      >
      > I think that may be a payor specific issue. For Medicare, it is at
      least 8 minutes up to 23 minutes.
      >
      > CPT Assistant Aug 2005 states in part.....................
      >
      > Several CPT codes used for therapy modalities, procedures, and
      tests and measurements specify that the direct (one-on-one) time
      spent in patient contact is 15 minutes. Providers report procedure
      codes for services delivered on any calendar day using CPT codes and
      the appropriate number of units of service. Under Medicare, for any
      single CPT code, providers bill a single 15-minute unit for treatment
      greater than or equal to 8 minutes and less than 23 minutes.
      > If the duration of a single modality or procedure is greater than
      or equal to 23 minutes to
      > less than 38 minutes, then 2 units should be billed. Time
      intervals for larger numbers of units
      > are as follows:
      > Units Reported on the Claim Number Minutes
      > 3 units > 38 minutes to < 53 minutes
      > 4 units > 53 minutes to < 68 minutes
      > 5 units > 68 minutes to < 83 minutes
      > 6 units > 83 minutes to < 98 minutes
      > 7 units > 98 minutes to < 113 minutes
      > 8 units > 113 minutes to < 128 minutes
      >
      > Does this help ?
      >
      > Barbara Burgess, RN, CPC, ACS-EM, PCS
      >
      >
      > djgeisel <djgeisel@...> wrote:
      > When using a timed code, for instance one that
      specifies "first 15
      > Min." and you are doing less that that, we append a 52 modifier. Is
      > there anything that specifies a minimum time that must be spent to
      use
      > the code? This question was asked to me and I can't find anything
      on
      > that. Thanks for your help. Diana
      >
      >
      >
      >
      >
      >
      > ---------------------------------
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      > [Non-text portions of this message have been removed]
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