Aggregate Timed Units

CPT Codes are considered timed or untimed. Untimed codes are limited to one unit of service per visit, regardless of the amount of time spent on the service. These are sometimes referred to as occurrence based codes. Examples include PT Evaluation (97001) and Unattended Electrical Stimulation (97014). The number of units of Timed Codes are based on the amount of time spent on the service. Examples include Joint Mobilization (97140) and Therapeutic Exercise (97110). These are aggregated in 15-minute units for most rehabilitation services.

Rounding Rules

Payers may have differing rules to consider when rounding time to calculate the proper number of units. The “8 Minute Rule” required by CMS is the best known of these rounding rules. See the following table for examples of Rounding Rules. Clinicient uses 8 minute rounding for timed units for all payers by default, but this setting may be changed for individual payers.

Eight Minute Rounding Units
1–7 Minutes 0
8–22 Minutes 1
23–37 Minutes 2
38–52 Minutes 3

Max Units

Some payers cap the number of allowed units in a visit. For example, CMS allows one unit of timed procedures for each 15 minutes spent on timed services. In Insight, this is called “CMS Rounding Rule” and is illustrated in the table below:

Minutes Spent on Timed Services Max Units Allowed
1–22 Minutes 1
23–37 minutes 2
38–52 Minutes 3
53–67 Minutes 4

For example, using the eight-minute rounding rule without applying the CMS cap in a 27-minute visit:

Procedure Time Units
Therapeutic Exercise 10 minutes 1
Joint Mobilization 9 minutes 1
Ultrasound 8 minutes 1
Total Units   3

Using eight-minute rounding with the CMS Rounding Rule would allow a maximum of two units in a 27-minute visit. In the following example, Ultrasound would be trimmed:

Procedure Time Units
Therapeutic Exercise 10 minutes 1
Joint Mobilization 9 minutes 1
Ultrasound 8 minutes 0
Total Units   2
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