Reimbursement Rates For Occupational Therapy
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FAQ
Note how 1 billable unit for a timed code must be at least 8 minutes, and it does not increase to a second billable unit until you have at least 8 minutes past the 15-minute mark. If more than one timed CPT code is billed during a calendar day, then the total treatment time determines the number of units billed.
The Three Occupational Therapy Evaluation Codes 97165 ? Occupational therapy evaluation: low complexity. 97166 ? Occupational therapy evaluation: moderate complexity. 97167 ? Occupational therapy evaluation: high complexity.
To calculate the number of billable units for a date of service, providers must add up the total minutes of skilled, one-on-one therapy and divide that total by 15. If eight or more minutes remain, you can bill one more unit.
Medicare 8-minute rule TimeUnits38 ? 52 minutes3 units53 ? 67 minutes4 units68 ? 82 minutes5 units83 minutes6 units2 more rows
Designation of Time Units. Number of Minutes. 1 unit. 8 minutes to < 23 minutes. 2 units. 23 minutes to < 38 minutes. 3 units. 38 minutes to < 53 minutes. 4 units. 53 minutes to < 68 minutes. 5 units. 68 minutes to < 83 minutes. 6 units. 83 minutes to < 98 minutes. 7 units. 98 minutes to < 112 minutes.