Which CPT Codes Require Direct One-on-One Contact

August 13, 2018
Rick Gawenda

In July, I wrote and published an article “Can I Double Book or Overlap Medicare Patients“. In that article, I explained the definition of “requires direct one-on-one patient contact” and how to do the proper billing when treating 2 or more patients during the same time period, whether Medicare or non-Medicare. In this article, I will provide which CPT codes require the therapist or assistant have direct one-on-one patient contact in order to bill that CPT code to the patient for that visit.

According to the American Medical Association, the following CPT codes require direct one-on-one patient contact for physical and occupational therapy services:

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  1. Rick,
    In previous GS posts, you mention that a provider cannot be one-to-one with more than one patient at a time. Would I be correct in saying that when a provider hands-off Patient A to the rehab technician and begins providing one-on-one care to Patient B, the time the support personnel spent with Patient A is no longer billable using the CPTs you listed above? Thanks.

    1. That would not be true assuming you are allowed to use support personnel under your supervision by your state practice act and the insurance Patient A has allows the use of support personnel.

      1. I’m really confused by all of this because I thought the whole point of one-on-one timed codes is that you could not hand off a patient to an aide for exercises, which you bill for, while at the same time doing manual on a another patient which you also bill for. But you’re saying this is ok for some non-Medicare insurances?? How do you know which one? I don’t know where to look to begin to find this out. If the insurance does not specify whether this is allowable but the practice act allows it, then is it still ok?

  2. Hello Rick,
    If during the transition of a patient from an OT to a SP there is a 15 minute overlap in which both therapists are in the room at the same time and the speech therapist is beginning treatment, The question is are we still meeting the requirement for OT one-on-one if there is a 15 min cotreat with speech therapist in the room? I guess the bottom line is can we bill 15 min of OT if Speech therapy being done at same time?

    1. My opinion, no as how can the patient be receiving 2 disciplines of therapy during the same time period and each billing for the same time period.

  3. When setting up an ultrasound, using a hands free unit, can the therapist bill for this ultrasound using CPT 97035 if they leave the patient to start another patient on exercises?

  4. I contacted APTA and they responded that services provided provided by aides are not billable because they are not considered a Qualified Health Professional.

    1. That would not be correct. If your state practice act allows you to use support personnel and the insurance carrier that the patient has allows the use of support personnel, then the PT can use support personnel to provide delegated services and those services would be billable to the insurance carrier.The support personnel (rehab aide, rehab tech, ATC) is an extension of the PT.

      1. My understanding is that the CPT guidelines dictate that services need to be provided by a Qualified Health Professional. Is this incorrect?

        1. If that was correct, then a PTA or an OTA could not provide therapy services since they are not considered a qualified healthcare professional.

  5. Is it legally possible, regardless of payor source, for one licensed physical therapist to deliver more that 4 units of direct one-on-one care in 60 minutes?

    In a double-booked patient care scenario, one licensed physical therapist (alone, no PTAs or PT aides) treats 2 follow-up patients simultaneously in the same 60 minute time period; both patient’s sessions started at 9am & ended at 10am. Each patient received 8 minutes of manual therapy & the remainder of time performed therapeutic exercise allowing necessary time for rest, station transitions, etc. No other treatment interventions were rendered to either patient.
    *What is the maximum number of units of direct one-on-one care that this therapist may list for each patient?

    1. Simple answer, it is possible. It would depend on insurance carrier and number of different types of interventions provided.

      1. Thank you for your reply to question one; very much appreciated.

        For question 2, perhaps I omitted information necessary to answer? If this was the case, please allow me to add that the 8 minutes of manual therapy for each patient occurred at different times within the same hour, & that rest times were very minimal, essentially enough time to transition between stations (ie. no extended rest periods for either patient). Please allow all other scenario conditions specified to remain unchanged.

        *So, assuming each patient will be billed one unit each of manual therapy, what is the maximum number of units of therapeutic exercise that may be billed to each patient? Many thanks!