Medicare Claims Processing Manual (Pub. 100-04), Ch. 5 § 20.3
Determining What Time Counts Towards 15-Minute Timed Codes - All
20.3 - Determining What Time Counts Towards 15-Minute Timed Codes - All
Claims
(Rev. 1, 10-01-03)
Providers report the code for the time actually spent in the delivery of the modality
requiring constant attendance and therapy services. Pre- and post-delivery services are
not to be counted in determining the treatment service time. In other words, the time
counted as “intra-service care” begins when the therapist or physician (or an assistant
under the supervision of a physician or therapist) is directly working with the patient to
deliver treatment services. The patient should already be in the treatment area (e.g., on
the treatment table or mat or in the gym) and prepared to begin treatment.
The time counted is the time the patient is treated. For example, if gait training in a
patient with a recent stroke requires both a therapist and an assistant, or even two
therapists, to manage in the parallel bars, each 15 minutes the patient is being treated can
count as only one unit of code 97116. The time the patient spends not being treated
because of the need for toileting or resting should not be billed. In addition, the time
spent waiting to use a piece of equipment or for other treatment to begin is not considered
treatment time.