How to Accurately Bill Timed and Untimed CPT Codes in Physical Therapy

 

Accurate medical billing for physical therapy services is critical for healthcare providers aiming to avoid denials, stay compliant, and receive proper reimbursement. One of the most essential aspects of this process is understanding the distinction between timed and untimed CPT codes.

Timed codes are billed based on the therapist’s one-on-one time with the patient, typically measured in 15-minute units. In contrast, untimed codes are billed just once per session, regardless of how long the service was provided. Both types must be billed with precision to ensure compliance with insurance payer rules, including Medicare.

What Are Timed CPT Codes?

Timed CPT codes apply when the therapist delivers direct, face-to-face skilled care. These services follow the 8-minute rule, used by Medicare and most private payers to determine the number of billable units.

How to Bill Timed CPT Codes

❖ Track Direct Treatment Time
Only the time spent providing skilled, hands-on therapy should be recorded. Exclude minutes spent on documentation, setup, or rest periods.

❖ Apply the 8-Minute Rule
Use this chart to determine the number of units:

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

Add the total time across all timed services in a session and apply the rule accordingly.

❖ Choose the Correct CPT Code
Match the treatment to its corresponding code:

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

❖ Document Clearly
List the time spent, code used, and the patient’s response. Good documentation supports medical necessity and speeds up claim approvals.

 

What Are Untimed CPT Codes?

Untimed CPT codes are for services that don’t require continuous supervision. These are billed once per session—not based on time.

Examples include:

• 97010 – Hot or cold packs
• 97012 – Mechanical traction
• G0283 – Unattended electrical stimulation (used for Medicare)

How to Bill Untimed CPT Codes

❖ Identify Untimed Services
Recognize treatments that fall under this category to prevent overbilling.

❖ Bill One Unit per Service
Regardless of whether the service takes 5 or 25 minutes, you can only bill one unit per session for each untimed procedure.

❖ Document Medical Necessity
Even though time tracking isn't required, you must justify why the service was needed (e.g., pain management, inflammation control).

❖ Describe the Service Rendered
Detail how the therapy was delivered and how it ties into the overall treatment plan or diagnosis.

Tips for Accurate Billing

❖ Record Exact Start and End Times
Especially for timed services, vague entries like "30 mins exercise" can lead to audits or rejections. Instead, write:
“Therapeutic Exercise: 10:00 AM – 10:30 AM.”

❖ Avoid Billing Untimed Codes Multiple Times
Codes like 97014 (unattended electrical stimulation) should be billed only once per visit. Important: Medicare doesn’t recognize 97014—use G0283 instead.

❖ Exclude Set-Up and Rest Time
Only active treatment minutes are billable. Avoid counting time spent preparing equipment or letting the patient rest between exercises.

Why Outsourcing Billing Is a Smart Move

With so many coding rules and compliance requirements, many practices struggle with in-house billing. That’s why outsourcing to offshore medical billing and coding services in India has become a strategic decision for physical therapy clinics.

Info Hub Consultancy Services (ICS) is a trusted name in this space. With 200+ certified coders and a decade of experience in medical billing for physical therapy services, ICS ensures every code is accurate, every rule is followed, and every claim is fully supported by documentation.

ICS applies the 8-minute rule accurately, understands the nuances between therapeutic exercise and neuromuscular re-education, and helps clinics reduce denials and improve reimbursement rates.

Action Point: Outsourcing to a reliable partner like ICS can simplify your billing process, reduce administrative burden, and improve cash flow for your practice.

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.

 

Read Detailed Blog @ https://infohubconsultancy.com/blog/how-to-accurately-bill-timed-and-untimed-cpt-codes-in-physical-therapy/