Billing correctly in physical therapy begins with understanding the difference between timed and untimed CPT codes. Timed codes are billed based on the actual time a therapist spends providing direct care to a patient typically in 15-minute units. Whereas untimed codes are billed only once per session, regardless of the duration of the service. As a result, every therapist needs to know how to properly use these codes to ensure accurate reimbursement, avoid claim denials, and maintain compliance with payer requirements. This blog will discuss the process to be followed to bill timed and untimed CPT codes in physical therapy accurately.

What are Timed CPT Codes?

Timed CPT codes are used for physical therapy services that involve one-on-one interaction between the therapist and the patient. In fact, each unit of service usually equals 15 minutes. These codes follow the 8-minute rule, which determines how many units can be billed based on the total time spent. Also, the rule applies to Medicare and many private insurance payers.

How to Bill Timed CPT Codes

Billing timed CPT codes involves tracking the exact minutes spent on each service and calculating the number of billable units according to the billing rules. The steps to be followed for timed CPT codes for accurate billing –

❖ Track Direct Treatment Time

The first step in billing timed CPT codes is to carefully track the exact number of minutes you spend providing direct care to the patient. This means only the time during which the therapist is actively engaged in skilled, one-on-one treatment with the patient should be counted. But the time spent on non-treatment tasks, such as documentation or patient education without direct contact, should not be counted.

❖ Apply the 8-Minute Rule

Once the total treatment time is recorded, use the 8-minute rule to calculate the number of billable units. This rule helps determine how many 15-minute units you can bill based on the time spent. The units are broken down as follows:

• 8 – 22 minutes = 1 unit
• 23 – 37 minutes = 2 units
• 38 – 52 minutes = 3 units
• 53 – 67 minutes = 4 units

Add the total time spent across all timed services in a session and then match it with the appropriate unit range. This ensures your billing stays accurate and compliant with payer requirements.

❖ Choose the Correct CPT Code

After calculating the number of units, you need to assign the correct CPT code based on the service provided. The different treatment types have specific CPT codes. For example –

• 97110: Therapeutic exercise
• 97112: Neuromuscular re-education
• 97530: Therapeutic activities

Selecting the appropriate code ensures that the billed service matches the actual treatment provided.

❖ Document Clearly and Completely

Proper documentation is essential for billing timed CPT codes. Your treatment notes should include the total time spent on each specific service, the CPT code used, and the patient’s response to the treatment. This helps justify medical necessity, supports claims during audits, and ensures smooth reimbursement from payers.

What are Untimed CPT Codes?

Untimed CPT codes refer to services that are billed once per session, no matter how long they last. These services do not require direct supervision for the entire time and are not dependent on the number of minutes the therapist spends with the patient. The common examples include hot or cold packs and unattended electrical stimulation.

How to Bill Untimed CPT Codes

Billing untimed CPT codes is more simple as they are not time-based. But you still need to ensure accurate documentation. Below are the key steps to follow

❖ Identify Untimed Services

The first step is to recognize which services are classified as untimed CPT codes. These services do not require constant supervision or time tracking. The examples of commonly used untimed codes in physical therapy include

• 97010 – Application of hot or cold packs
• G0283 – Unattended electrical stimulation
• 97012 – Mechanical traction therapy

These treatments are generally passive in nature and are billed only once per session, regardless of the actual time spent.

❖ Bill One Unit Per Session

You only need to bill one unit per session for each service provided with untimed codes. Whether the treatment takes 5 minutes or 25 minutes, the number of units billed remains the same. This makes the billing process straightforward but still requires attention to detail in documentation.

❖ Ensure Medical Necessity

Even though untimed services are not time-sensitive, it is still important to document why the service was medically necessary. For example, if a patient received a cold pack after manual therapy to reduce inflammation, your notes should explain this purpose. Therefore, medical necessity supports the legitimacy of the claim and helps prevent denials.

❖ Record the Service Provided

Every therapist should clearly document the service provided. This includes describing the service, how it was administered, and the patient’s diagnosis or condition that required the treatment. Even untimed services must be tied to a clinical need and a specific goal in the treatment plan.

Tips for Accurately Billing Timed and Untimed CPT Codes

Accurately Medical billing for physical therapy services using timed and untimed CPT codes requires understanding the rules, proper documentation, and correct application of coding guidelines. The following tips should be implemented to avoid denials and ensure correct reimbursement

❖ Document Start and End Time Clearly

To avoid issues during audits or insurance reviews, it is important to record the exact start and end times of each timed therapy service you provide. In fact, vague entries like “30 minutes of exercise” won’t hold up under scrutiny and can lead to denied claims. Instead, write as: “Therapeutic Exercise: 10:00 AM – 10:30 AM.” This level of detail shows that you are billing accurately and within the rules.

Action Tip: Use an Electronic Health Record (EHR) system that allows precise time-stamping for each service. This not only supports compliance but also saves time when claims are reviewed or audited.

❖ Do Not Bill Untimed Codes More Than Once per Visit

Untimed CPT codes, such as 97014 (electrical stimulation, unattended) are designed to be billed only once per session, regardless of the therapy duration. Some clinics mistakenly bill multiple units for untimed codes which can raise red flags with payers and result in claim denials or even audits.

Important Note: Medicare does not recognize CPT code 97014. For Medicare patients, you must use HCPCS code G0283 instead when billing for unattended electrical stimulation.

Action Tip: Set up alerts or flags in your billing software for untimed codes so that billing staff are notified if an attempt is made to bill them more than once per visit. Also, regularly train your team on which codes are untimed to reduce errors.

❖ Don’t Include Rest or Set-Up Time in Timed Billing

Only the time you spend directly working with the patient on therapeutic activities can be billed under timed CPT codes. However, the time spent setting up equipment, letting the patient rest, or cleaning the room afterward should not be counted. These non-billable minutes can cause overbilling, leading to paybacks and penalties.

Action Tip: Train your staff to pause their time-tracking during set-up, rest, or other non-therapeutic activities. Also, consider using automated time logs that stop when the therapist steps away to ensure that only active treatment time is recorded.

Bonus Tip: Consider Outsourcing Outpatient Medical Billing & Coding Service Providers in India

Billing for physical therapy – especially when juggling both timed and untimed CPT codes, demands meticulous attention. InfoHub Consultancy Services ensures compliance by accurately applying the 8-minute rule to distinguish between therapeutic exercise and neuromuscular re-education. Our experts ensure that your practice always bills the right codes, with the right units, supported by the right documentation – every time.

Action Tip: To make your billing process easier and more accurate, consider working with offshore medical billing and coding services in India like ICS. We can help you choose the right codes, reduce claim errors, and speed up your payments.

FAQs

1. Can I bill multiple timed codes in the same session?

As long as you meet the minimum time for each and document them clearly.

2. Are co-treatment sessions billed differently?

Each therapist should bill only for the time they were actively involved.

3. How should missed minutes during a session be documented?

You should only bill for the actual time spent providing skilled therapy.

4. Can untimed and timed codes be billed together?

As long as each service is separately identifiable and documented.

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