July 19, 2018
As a reminder to providers, in the Payment Policy “Physical and Occupational Therapy Services,” there are unit limits identified for the various Physical and Occupational therapy modalities and therapeutic services. These limits are enforced in the Claims Editor. To avoid a claim edit, review the policy or review the criteria below which identifies the unit limits per classification of code.
Supervised Modalities (97012 – 97028): only one submission of a supervised modality procedure per date of service
Constant Attendance Modalities (97032 – 97039): codes represent 15-minute increments of time and are reimbursed for a maximum of 30 minutes or 2 units maximum on a single date of service
Therapeutic Procedures (97110 – 97140, 97530, 97760 - 97763): codes represent 15-minute increments and are reimbursed for a maximum of 60 minutes or 4 units maximum on a single date of service
Physical/Occupational Therapy Evaluation and Re-evaluation Procedures: one physical therapy or one occupational therapy evaluation or re-evaluation in addition to any combination of modalities and/or therapeutic procedures on a single date of service
Any 15 minute increment timed modality or therapeutic service rendered for less than 8 minutes should not be billed. A billable unit for a 15 minute increment code is 8-22 minutes or any multiples of this time range:
- 8 - 22 minutes equals 1 unit,
- 23 – 37 minutes equals 2 units
- 38 – 52 minutes equals 3 units
Any 30 minute increment timed modality or therapeutic service rendered for less than 16 minutes should not be billed. A billable unit for a 30 minute increment code is 16-45 minutes or any multiple of this time range:
- 16 – 45 minutes equals 1 unit
- 46 – 75 minutes equals 2 units
- 76 – 105 minutes equals 3 units
Modifier 52-Reduced service isn’t recognized with timed modality or therapeutic services.
Review the policy for complete details.