Untimed CPT Codes: How Much Time Must I Provide?

March 22, 2021
 / 
Rick Gawenda
 / 

Physical therapists (PTs), physical therapist assistants (PTAs), occupational therapists (OTs), occupational therapy assistants (OTAs) and speech-language pathologists (SLPs) have CPT codes which describe the interventions they provide that are time-based and service-based (untimed). A question I often receive is how much time must I spend providing an intervention that is service-based (untimed) in order to be able to bill for that CPT code to any insurance carrier, including the Medicare program? In this article, I will answer this question.

Question
How much time must I spend providing an intervention that is service-based (untimed) in order to be able to bill for that CPT code to any insurance carrier, including the Medicare program?

Answer

The content here is for members only log in here or sign up.

Question
Must I provide the untimed intervention for the complete median intra-service time in order to bill that CPT to an insurance carrier?

Answer

The content here is for members only log in here or sign up.


All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. Hi, is there a specific CPT code for SLPs to bill for caregiver education, speaking with MDs, etc? Or do they just document these details under the specific CPT code related to their education?

  2. Hi there. Are the pre and post service time the only time allotted for documentation for any codes? Are there any codes that our provider types can bill in addition for for report writing or documentation? We deal heavily with neuro patients and the documentation can be very comprehensive. Therapists are always asking me about codes for time spent writing up equipment recommendations, the most recent one was 6 pages for example. Or would you want to include that into one of the untimed codes listed above, like an eval or re-eval, for example?

    1. Documentation time is not separately billable time except for CPT code 96125. There is no CPT code for documentation time.

  3. If you are billing an untimed code along with a timed code, I would assume the 8 minute rules still apply? (Such as an L code with a fitting charge). If a total of 21 minutes is spent, can only one unit be billed since the 23 minute threshold was not met? Despite it being an untimed code.

    1. Medicare’s “8-minute rule” only applies to the 15-minute time based CPT codes and does not apply to any untimed CPT codes.

  4. If I am performing a low complexity initial evaluation, the CPT manual states typically 20 minutes are spent face to face, but since this is an untimed code can I spend maybe 5 minutes reviewing the history form and talking to the patient, and the rest of the time I charge a ther ex, 97110, for example, or manual. How would you interpret “typically”, would you follow half time for evaluation codes?

    1. I doubt you can do an evaluation in 5 minutes. Typical means what it usually takes knowing that same take longer and take shorter.

  5. Would you have an updated link or know the source for the intra-service time. Specifically for the newer Dry Needling CPT codes?