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2991Re: [MedicalBillers] Re: Billing question on timed codes

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  • B Burgess
    Mar 5, 2008
      I think I would interpret that as saying you do not need the 52 mod on a m'care claim if the service was provided for 8 to 23 minutes and as long as it was at least 8 minutes they will pay. If it was less than 8 minutes and the code states 15, then it may not be billable to m'care at all.......... but I can't say for sure. For other carriers, you may want to check with each one individually and if nothing definitive is stated then yes, I would use the 52 for less than 15 minutes. We also looked at BC/BS of Alabama guidelines for billing timed PT services, and it just stated "Special care should be given in reporting and documenting these services" and where there were time based codes referenced it said "each 15 minutes". It didn't say one way or another about using the 52 mod, but since that is a CPT rule and BC/BS doesn't say not to use it, then I would.

      I don't have any first hand experience with actually billing these codes or looking at rejections, this topic just happened to recently come up in our office when we were looking at some physical therapy services. We were looking into it from a documentation requirement standpoint though, and not at individual claims or what they paid.


      djgeisel <djgeisel@...> wrote:
      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
      > the code? This question was asked to me and I can't find anything
      > that. Thanks for your help. Diana
      > ---------------------------------
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