Medicare Claims Processing Manual (Pub. 100-04), Ch. 5 § 20.3

Determining What Time Counts Towards 15-Minute Timed Codes - All

Last amended: 2003Year: 2003Length: 212 wordsOfficial source
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.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 5 § 20.3: Determining What Time Counts Towards 15-Minute Timed Codes - All | Justis AI