Physical Medicine– Active/Passive
The number of Passive therapeutic procedures/modalities allowed when an active therapeutic procedure is billed was changed to 2 effective 7/1/16 for dates of service on or after 7/1/16. The total of 8 units/procedures/modalities did not change (of which only 2 may be passive) when an active therapeutic procedure is performed.
Services of less than 8 minutes when that is the only service performed during a visit is not billable. Time intervals are incremented in 15 minute units (base is 8 minutes):
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-67 minutes = 4 units, etc
- When more than one service of a timed modality is performed in a single day, the total minutes of the service performed should be included in the patient record to substantiate the level of service. A total of 8 units of active and passive therapy may be billed per visit. If active therapy is being applied, only two units of a passive modality may be included in the 8 units.
- Passive therapies (listed in U&T Guidelines) will be limited to 4 units per visit, if only passive therapy is being applied. Note: Only 2 units may be billed if active therapy is being applied.
- All timed codes must have the time documented (in minutes) in the office notes submitted for each code billed for reimbursement. Time needs to be actual time spent in the activity, not time based on the description of the code.
- Therapy codes billed must have part of body documented or it must be clearly identified in a flow sheet or other attached documentation. If the procedures are clearly documented in the notes, a flow sheet is unnecessary. If the notes do not support the procedures billed but refers to a flow sheet then the flow sheet must be attached.