Time-based physical therapy codes are designed to reflect the amount of direct treatment time spent with a patient. According to CMS rules, the correct method for calculating the duration for billing purposes is based on 15-minute increments.
When billing for physical therapy services, a provider must document the total time spent in delivering the therapy. For services that are billed based on time, it’s critical that this time adheres to the 15-minute increments, meaning that each increment represents 15 minutes of total treatment time. If a session lasts for 30 minutes, for instance, it would be appropriate to code it as two units since it encompasses two full increments of 15 minutes each.
The requirement to bill in these specific increments ensures a standardized approach to coding and billing, allowing for consistency across different practices and providers. This aligns with guidelines to ensure fair reimbursement for the services provided based on the actual treatment time.
Therefore, understanding this 15-minute increment requirement is essential for anyone involved in outpatient physical therapy billing and compliance, helping to ensure that services are accurately captured and reimbursed correctly.