After providing therapy services to patients, do not fall into the “to be, or not to be—to bill, or not to bill” situation, just go ahead and bill it for reimbursement.
But wait a minute!
Are you confused between timed and untimed CPT codes for the therapy services?
Well, don’t be.
It is true that slight errors in bills can cost you more in account of denied claims as billing for therapy procedures can be tricky and time-consuming. However, understanding them and decoding codes accurately for preparing bills can decline the rate of denials.
What are Timed CPT Codes?
Timed CPT Codes are based on the amount of time the provider i.e. therapist spends with a patient while providing treatment. The time is determined in the intervals of 15 minutes. For instance, a 50 minute appointment would be billed as 3 units of the appropriate timed CPT code. It is essential for providers, while submitting claims, to calculate time and enter right codes defined by the number of time units.
What are Untimed CPT Codes?
Untimed CPT Codes are described as codes that are recorded once per date after patients receive services regardless of how much time a therapist spends providing the relevant treatment. Untimed codes are also called service based or session-based codes.
Simply, these codes denote a one-time therapy service provided to a patient; and you can only bill the code once regardless of how much time you spend providing treatment to the patient.
For instance, a physical therapist may treat a patient using therapeutic exercises. No matter if the exercises take 20 minutes or 1 hour, the physical therapist will bill the insurance company once using the Untimed CPT Code for therapeutic exercises.
How to know if CPT Codes are timed or untimed?
The practice, while preparing bills, to know what codes are timed is checking its descriptor. If the descriptor says statements like “every after 15 minutes”, it is officially considered as timed code because it shows a particular unit time.
In contrast, if a code descriptor does not show any unit of time, it means that the code is untimed or service-based code. In other words, you can say that untimed codes are indifferent to time.
Billing Timed CPT Codes
Billing timed CPT codes is easy once you understand the key terms and rules. The most important thing to know is the Medicare 8-minute rule. This rule states that you can only bill for a timed CPT code if you spend at least 8 minutes of face-to-face time with the patient.
Below is the chart from which you can easily find out how to calculate billable units. For example, time spent with a patient from 8 to 22 minutes is considered as 1 billable unit, and so on. It is to be noted that bills prepared for time spent less than 8 minutes cannot be accepted by the payers.
Medicare 8-Minute Rule Reference Chart
| Billable Units | Time Frame in Minutes |
| 1 unit | 8 to 22 minutes |
| 2 units | 23 to 37 minutes |
| 3 units | 38 to 52 minutes |
| 4 units | 53 to 67 minutes |
| 5 units | 68 to 82 minutes |
| 6 units | 83 to 97 minutes |
| 7 units | 98 to 112 minutes |
| 8 units | 113 to 127 minutes |
How to Determine Billable Units?
The billable units can be determined by two ways with reference to the payers following CMS and AMA 8-minutes rule.
CMS 8-Minute Rule
According to CMS (Center for Medicare and Medicaid Services) 8-minutes rule, it requires at least 8 minutes of one-on-one treatment for each billable unit. The total time spent with patients is summed and then the billable units are calculated according to the chart shared above.
For instance, a therapist bills 9 minutes of code 97112 and 10 minutes of code 97350, and 8 minutes of code 97535. After totaling the total direct time spent with a patient, it becomes 27 minutes of treatment which are 2 billable units for the payers following CMS 8-minute rule.
AMA 8-Minute Rule
The AMA (American Medical Association) 8-minute rules are slightly different from the CMS 8-minute rule. It is also called the midpoint rule. The providers can only bill for treatment when the midpoint is surpassed. According to the rule, the amount of time spent is not calculated as a whole, instead the practitioners can bill for each separate unit. You, as a provider, cannot bill for a unit, however, if the one-on-one treatment lasts for 8 minutes.
For example, if a provider bills 8 minutes of Code 97350, 8 minutes of 97112, and 8 minutes of 97535. This becomes a total 24 minutes of time spent with a patient in one-on-one condition. Payers following AMA rule will deal it as 3 units. In contrast, only two units for payers following the CMS 8-minute rule. i.e. 2 units are calculated when the one-on-one time ranges between 23 to 37 minutes.
Timed and Untimed CPT Codes List
Below are some examples of commonly used timed and untimed CPT codes:
| Timed Codes | Untimed Codes |
| 97350: Therapeutic Activities: Use of dynamic activities to improve functional performance e.g. lifting, pushing, pulling, reaching, throwing, functional mobility, and transfer training. | 97165: Occupational therapy evaluation, low complexity |
| 97535: Self Care/Home Management Training: treatments directly applied to self-care and home management activities. | 97166: Occupational therapy evaluation, moderate complexity |
| 97710: Therapeutic Exercises: (one or more areas, every 15 minutes) To develop strength and endurance, range of motion, and flexibility. | 97167: Occupational therapy evaluation, high complexity |
| 97542: Wheelchair Management – Includes evaluation, fitting, and training. | 97168: Re-evaluation: used when there is change in functional status or plan of care |
| 97112: Neuromuscular Re-education – Interventions focused on restoring balance, coordination, kinesthetic sense, posture, and proprioception. | 97014: Electrical stimulation therapy (unattended) |
| 97129: Cognitive Skills: (only initial 15 minutes) work directly with the patient to help him improve thinking, remembering, reasoning, and problem solving and the ability to plan, organize, and carry out tasks in a practical. Any additional unit is billed under 97130. | 97018: Paraffin bath therapy |
| 97035: Ultrasound | 97022: Whirlpool/Fluidotherapy |
| 97032: Electrical Stimulation (manual)- Functional Electrical Stimulation (FES) or Neuromuscular Electrical Stimulation (NMES) while performing a therapeutic exercise or functional activity may be billed as 97032. | 97024: Diathermy |
Common Billing Mistakes
Billing mistakes can lead to reimbursement delays or claim denials. Actions whether accidently or intentional bring consequences. Therefore, billing errors should be strictly avoided. However, some common mistakes are:
- Inaccurately recording treatment time
- Providing insufficient documentation to support your claims
- Miscoding i.e. wrongly decoded modifiers
Timed CPT Codes vs Untimed CPT Codes: Comparison Table
| Feature | Timed CPT Codes | Untimed CPT Codes |
| Billing Basis | Time spent providing treatment | Service provided, regardless of time |
| Time Intervals | 15-minute units | N/A |
| Units Billed | Multiple units per service, based on time intervals | One unit per service |
| Examples | Therapeutic exercise, manual therapy | Evaluation, hot/cold packs |
| Billing Considerations | Accurate time tracking crucial | Service documentation essential |
| Code Structure | Often include time designations (e.g., 1 unit, 2 units) | No time designations |
| Flexibility | Allows for billing variations based on treatment duration | Less flexible, billing is standardized |
| Potential for Overlapping Services | Lower, as time intervals help differentiate services | Higher, careful documentation needed to avoid duplicate billing |
| Coding Complexity | Can be more complex due to time calculations | Generally simpler to code |
| A table sharing key distinctions between Timed and Untimed CPT Codes. | ||
Conclusion
Understanding timed and untimed CPT codes is necessary if you are a healthcare provider. Providers often fall in the ditch of denied claims and bulk of losses because of not billing appropriately for the services they provided. There might be many complexities i.e. counting of time, determining billable units, and defining accurate codes.
Therefore, the best solution is to outsource your medical billing and coding to the Best Medical Billing Company. We will handle all the coding and claim submission difficulties, so that you don’t have to go beyond the call of duty and find yourself trapped inside the physician burnout bubble!
FAQs
What is the difference between timed and untimed PT codes?
Timed codes are bills according to the one-on-one time spent with a patient. While untimed codes are billed once regardless of time limit.
Is 92507 timed or untimed?
CPT code 92507 is service-based or untimed code. It is related to the group of speech-language pathology codes that do not require time units, and do not depend on how much time a therapist spends with a patient.
Are timed codes usually more expensive?
Yes, timed codes are generally more expensive since the bill depends on how long the therapy session lasts. Untimed codes have a fixed rate regardless of time.
How do I know if a CPT code is timed or untimed?
You can check the CPT code description. Timed codes will specify a time unit, such as 15 minutes. Untimed codes will not mention a time unit. You can also check with your insurance provider, as they maintain lists of which codes are timed vs. untimed.
Do therapists prefer timed or untimed codes?
It depends on the therapist and situation. Timed codes can potentially generate higher revenue if longer treatment times are needed. However, untimed codes provide more predictability and stability. Many therapists utilize a mix of both timed and untimed codes.
What are some examples of common timed CPT codes?
Some common timed CPT codes include:
- 97110 – Therapeutic exercise, 15 minutes
- 97530 – Therapeutic activities, 15 minutes
- 97140 – Manual therapy, 15 minutes
What are some examples of common untimed CPT codes?
Some common untimed CPT codes include:
- 97001 – Physical therapy evaluation
- 97002 – Physical therapy re-evaluation
- 97003 – Occupational therapy evaluation
- 97004 – Occupational therapy re-evaluation
- 92507 – Speech-language pathology treatment of language speech sound production
