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PAP228

Billing Timed Procedures


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/September 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Billing Timed Procedures

CPT procedure codes may be timed procedures with the descriptions indicating services performed for "each 15 minutes". Time is actual face to face time spent with the patient.

Per CPT and CMS requirements, to help define the number of units to bill for the procedure, you must determine the time spent performing the procedure. A unit of time is attained when the midpoint is passed. For example; 15 minutes is attained when 8 minutes have elapsed (more than midway between 0 and 15 minutes).

  • 0 - 7 minutes = 0
  • 8 - 22 minutes = 1 unit
  • 23 - 37 minutes = 2 units
  • 38 - 52 minutes = 3 units
  • 53 - 67 minutes = 4 units
  • 68 - 82 minutes = 5 units
  • 83 - 97 minutes = 6 units
  • 98 - 112 minutes = 7 units
  • 113 - 127 minutes = 8 units

Please indicate total units in box 24 G of the CMS1500 claim form.

This excludes billing units for anesthesia (see PAP500)


Policy History

Date Action Reason
September 2014 Revised Language revision
January 2012 Revised Updated units
July 2009 Revised Language clarification to last two paragraphs
May 2008 Revised Anesthesia language added

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