Question on PT Manual Billing

[fozzy40]

I have a patient that was recently seen by a very manual based therapist (it appears.) I just have a question regarding how this is billed.

This was the billing for one visit.

15 units = 97110
2 units = 97140
1 unit = 97530 (modified 59)

My questions are:
1) Does the unit equate to a specific time spent?
2) How much do these typically reimburse (non-medicare rate) approximately?

Thanks again!

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[jesspt]

I have a patient that was recently seen by a very manual based therapist (it appears.) I just have a question regarding how this is billed.

This was the billing for one visit.

15 units = 97110
2 units = 97140
1 unit = 97530 (modified 59)

My questions are:
1) Does the unit equate to a specific time spent?
2) How much do these typically reimburse (non-medicare rate) approximately?

Thanks again!

Well, the 97110 is a therapeutic exercise code. One unit=15 minutes of time (generally). The 97140 is a manual therapy code, and the 97530 is a therapeutic activity code with a 59 modifier attached to delineate that these activities ar edistinct and seperate form the therapuetic exercises which were done.

Have you seen other bills for other treatment dates? Just at first glance, I'd say the 15 units for the 97110 code is an error.

Reimbursement can vary wildly, but you can expect anywhere between $35-$75 per unit for most of these codes unless the patient's plan only provides a per diem rate such as $75 per session no matter the number of units billed.

 

[facetguy]

I have a patient that was recently seen by a very manual based therapist (it appears.) I just have a question regarding how this is billed.

This was the billing for one visit.

15 units = 97110
2 units = 97140
1 unit = 97530 (modified 59)

My questions are:
1) Does the unit equate to a specific time spent?
2) How much do these typically reimburse (non-medicare rate) approximately?

Thanks again!

97110: 15 units x 15 minutes = 3 hours, 45 minutes

97140: 2 units x 15 minutes = 30 minutes

97530: 1 unit x 15 minutes = 15 minutes

That's 4.5 hours, face-to-face hands-on care.

That's one heck of a visit. Add in a couple bathroom breaks, lunch and a nap...it's a whole day affair. (Is there a nap code, by the way?)

And will this be done 3x/week? Daily?

 

[Sheldon]

That's an error in billing....or fraud. I hope it's an error.