A guide to billing units in physical therapy for beginner medical billers

8 minute rule therapy

Medical billing can be a complex process, but it doesn't have to be. In this article, we will provide a basic guide for beginner medical billers who want to learn more about the different types of billing units and how to correctly bill them. By understanding the basics of billing units, you will be able to start billing medical procedures correctly and efficiently.

What are billing units and what do they mean for medical billers?

Billing units are a way to measure the time spent providing treatment to a patient. This is important for medical billers because it helps them to accurately bill Medicare for the services provided.

The 8-minute rule is used to determine billing units for physical therapy services. This rule states that a PT must provide an 8-minute one-on-one service in order for the service to be billed. The CPT codes for physical therapy services are further broken down into billing units on the basis of time intervals so that billers can determine how long a therapeutic service has been performed.

Billing units in physical therapy can be confusing for beginner medical billers. but with a little understanding of the 8-minute rule, you'll be able to accurately bill Medicare for the services you provide.

The 8-minute rule therapy states that a PT must provide an 8-minute one-on-one service in order for the service to be billed. This means that billing units are broken down into time intervals so that billers can determine how long a therapeutic service has been performed.

How do you know which type of billing unit to use for a particular procedure code?

Medical billers need to be aware of the billing units that correspond to specific procedure codes. In order to accurately bill for services provided, it's important to understand the billing unit and its corresponding time frame.

CPT codes 97530 and 97110 are both time-based therapy codes. This means that the billing unit is based on the time a therapist spends with a patient. According to Medicare, the number of billable units documented in a day by the licensed therapist will be paid after dividing them by 15. If the reminder left is more than the number 8 but less than 15 then the therapist will be paid as one additional unit.

It's important to note that not all procedure codes are billed using time-based billing units. For example, CPT code 96118 (manual therapy) is billed using service units rather than time units. The number of service units billed for a particular procedure code is based on the complexity of the service provided.

How do you calculate the amount that should be billed for a procedure code using billing units?

To calculate the billing amount for a procedure code, you will need to know how many units are associated with that code. For time-based codes, billing is based on the number of units spent on a patient. Medicare has a set billing rate for these codes, which is divided by 15 to determine the amount that will be paid. If a therapist spends more than 8 but less than 15 minutes with a patient, one unit will be billed.

Conclusion:

Billing units in physical therapy can be confusing for beginner medical billers. However, with a little understanding of the 8-minute rule and how billing units work, you'll be able to accurately bill Medicare for the services you provide. Be sure to know which billing unit corresponds to each procedure code in order to correctly calculate the amount.

The above information was written after thorough research and most points were picked up from a detailed article written by HMS USA LLC Medical billing company in NY. If you want further information about Billing Units in Physical Therapy do check out their blog.