November 7, 2019
If you bill a CPT or HCPCS procedure code that contains a time element, such as each 15 minutes, additional 30 minutes, or each hour, it is critical to understand when a unit of time is reached.
The American Medical Association’s official CPT Professional Codebook guidelines indicate that a unit of time is reached as follows:
“A unit of time is attained when the midpoint is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes). A second hour is attained when a total of 91 minutes has elapsed. When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used.”
If the mid-point of a time element code has not been exceeded, the service can’t be billed or an additional unit of time can’t be added to the initial timed code.
Examples of common time increments, and appropriate units include:
15-minute increment timed service: The time midpoint is 8 minutes; 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
30-minute increment timed service: The time midpoint is 16 minutes; 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
The use of Modifier 52-Reduced Service on a time element code is not appropriate to represent a lesser amount of time than indicated in the code description. Use of this modifier with a timed code will be denied reimbursement as an inappropriate modifier-procedure combination. Use a timed code that more accurately represents the actual time rendered, combine the time with another timed code such as another physical therapy modality, or do not bill the service at all if the time mid-point has not been exceeded.
Review the following payment policies for more details: