Support Tool One of the most confusing concepts within the muscle therapy realm is the difference between massage and manual therapy. These two services are remarkably similar, but with important distinctions. Download, review and save this document to better understand the indications and goals for these services. Later in this course you’ll learn more about…
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes.
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It can be a challenge to navigate the world of timed codes. The first step is to have a solid understanding of the different types of procedure codes such as supervised modalities, constant attendance modalities and therapeutic procedures. This tutorial provides a nice simple breakdown of each of the levels of service.
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes.
Click here to learn more.
Support Tool One of the most confusing concepts within the muscle therapy realm is the difference between massage and manual therapy. These two services are remarkably similar, but with important distinctions. Download, review and save this document to better understand the indications and goals for these services. Later in this course you’ll learn more about…
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes. Click here to learn more.
Much confusion exists around the Manual Therapy Techniques, procedure code 97140, and its required elements of documentation. Some practices employ manual therapy and muscle work along with Chiropractic adjustments. It’s important to know the limitations when they are performed and billed on the same visit. Payers make their rules, and you must be aware of…
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes. Click here to learn more.
The 8-Minute & 15-Minute Rule
In order to seek reimbursement for a unit of service for a constant attendance modality or a therapeutic procedure, the provider must spend at least eight minutes (just past the halfway point of 15 minutes) providing that service to the patient. According to CMS (Medicare) guidelines[1], if the service is performed for less than eight minutes, do not bill for the code. The 8-Minute Rule further dictates that in order to bill for additional time-based units, you must spend at least eight minutes providing one-on-one service to the patient to warrant the additional code. For any single timed CPT code on the same day, measured in 15-minute units, providers must bill a single 15-minute unit for treatment greater than or equal to 8 minutes through (and including) 22 minutes. If the duration of any single modality or procedure completed in a day is greater than or equal to 23 minutes (through and including 37 minutes) then 2 units are billed.
Total Billable Units
The units per number of minutes are calculated as follows:
| Units |
Time Window |
| 1 |
Greater than or equal to 8 minutes through 22 minutes |
| 2 |
Greater than or equal to 23 minutes through 37 minutes |
| 3 |
Greater than or equal to 38 minutes through 52 minutes |
| 4 |
Greater than or equal to 53 minutes through 67 minutes |
If multiple time-based services are performed on the same day in increments of 7 minutes or less and the total time is 8 minutes or greater, bill one unit for the service performed for the most minutes. This is allowed because the total time for all services was greater than the minimum time for one unit.
Note: only direct, one-on-one time with the patient is considered for timed codes.
Another easy calculation for billing multiple timed codes performed during the same visit is:
If 8 minutes or more are leftover, bill one additional unit. If 7 minutes or less are leftover, do not bill an additional unit.
[1] Medicare Claims Processing Manual, 100-4, Chapter 5, Sections 10, 20, 30, 40, 100 Medicare Benefit Policy Manual, 100-2, Chapter 15, sections 220 and 230
Download Support Tool What do you do when you feel or know you have documented your 9894X and 97140 CPT codes for the same visit correctly, you used the appropriate and correct diagnosis codes, appended the correct modifiers, all in accordance with the payer’s policy, but you get your services denied? The curbside appeal to…
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