Crystal's MCW Coder HubDefinition
A rule used by Medicare (and many payers) to determine how many billable units of a timed CPT code can be billed based on the total minutes of service provided.
The Logic
- 1 Unit = 15 Minutes.
- To bill 1 unit, you must provide at least 8 minutes of that specific service.
- Remainder minutes are aggregated to determine additional units.
Chart
| Total Minutes | Billable Units |
|---|---|
| 0 - 7 | 0 |
| 8 - 22 | 1 |
| 23 - 37 | 2 |
| 38 - 52 | 3 |
| 53 - 67 | 4 |
Example
Patient receives:
Calculation:
Mixed Remainders
If you have 7 mins of 97110 and 7 mins of 97140, you cannot bill separately. However, combined (14 mins), you still do not reach the 8-minute threshold for a second unit of either specific code. Rules vary on aggregating different codes; Medicare generally requires 8 mins per code to bill a unit of that code.