Forum - Questions & Answers

Sep 24th, 2020 - ChiroCasey

97110, 97530, 97012

My question is in regards to justifying adding a 97012 onto a timed billing code such as 97110 or 9530. Since they are timed do both codes need to be the full 15 min. increments in order to add on the 97012? Or can one be the full 15 increments and the other not. For example- a patient has 20 min of 97110 and 28 min of 97530 recorded. The 97530 is not at it's fullest (30 min) but the 97110 is over it's 15 min. Please advise, thank you!

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Oct 5th, 2020 - ChrisW   182  1 

re: 97110, 97530, 97012

You must document the time spent on each procedure and you cannot add one with the other as they are two separate procedures. In addition because these are time based you cannot bill the additional time with a modifier. Most payers require direct treatment for at least eight minutes according to the 8-minute rule. Generally, one 15-minute unit is 8-22 minutes for most payers.

See reference for billing using the PUB-100 from CMS for additional guidance, or contact your payer(s).
https://www.cms.gov/Medicare/Billing/TherapyServices/Downloads/clm104c05.pdf

C.
Counting Minutes for Timed Codes in 15 Minute Units When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed CPT code on the same day measured in 15-minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, then 2 units should be billed.

Time intervals for 1 through 8 units are as follows: Units Number of Minutes
1 unit: ≥ 8 minutes through 22 minutes
2 units: ≥ 23 minutes through 37 minutes
3 units: ≥ 38 minutes through 52 minutes
4 units: ≥ 53 minutes through 67 minutes
5 units: ≥ 68 minutes through 82 minutes
6 units: ≥ 83 minutes through 97 minutes
7 units: ≥ 98 minutes through 112 minutes
8 units: ≥ 113 minutes through 127 minutes

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