The Right Time for Billing Codes Here’s what you need to know about billing timed and untimed evaluation and procedure codes. Bottom Line
Bottom Line  |   March 01, 2018
The Right Time for Billing Codes
Author Notes
  • Neela Swanson is ASHA’s director of health care coding policy and advocacy.
    Neela Swanson is ASHA’s director of health care coding policy and advocacy.×
Article Information
Hearing Disorders / Practice Management / Bottom Line
Bottom Line   |   March 01, 2018
The Right Time for Billing Codes
The ASHA Leader, March 2018, Vol. 23, 30-32. doi:10.1044/leader.BML.23032018.30
The ASHA Leader, March 2018, Vol. 23, 30-32. doi:10.1044/leader.BML.23032018.30
Clinicians face daily pressures to do more in less time and to maximize payment for every minute. They may be asked to shorten evaluation and treatment sessions or report additional billing codes. To make informed and ethical decisions about reporting services for reimbursement, clinicians must understand how time factors into Current Procedural Terminology (CPT, ® American Medical Association)—the codes used on billing forms to report what was done in a session.
Are most audiology and speech-language pathology CPT codes untimed?
Yes, most audiology and speech-language pathology codes are untimed—that is, they don’t have a time unit in their descriptors and are considered “session-based.” Untimed codes may be reported once per day, regardless of the length of the session. Examples include CPT codes 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual) and 92557 (Comprehensive audiometry threshold evaluation and speech recognition).
How can I tell an untimed code from a timed code?
Timed CPT codes always have a distinct unit of time listed in their descriptors. For example, CPT 92620 (Evaluation of central auditory function, with report; initial 60 minutes) is reported for the first hour of the evaluation, and CPT 92621 (Evaluation of central auditory function, with report; each additional 15 minutes) can be reported multiple times if the evaluation lasts for more than an hour.
Other examples of timed codes include G0515 (Development of cognitive skills to improve attention, memory, problem-solving, direct [one-on-one] patient contact, each 15 minutes) and 96125 (Standardized cognitive performance testing, per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report). Codes that include “per hour” or “each 15 minutes” are billed multiple times per claim to reflect the total evaluation or treatment time.
Untimed codes have no associated time in their descriptors.
How do I appropriately report timed codes?
You can report a timed code if you have spent at least half of the code’s specified time with the patient. The “American Medical Association CPT 2018 Professional Edition” indicates that “A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes). A second hour is attained when a total of 91 minutes have elapsed.”
This concept, sometimes called the 51-percent rule, applies to codes that are reported in one-hour, 15-minute, and 30-minute units.
The Medicare program has published additional rules related to 15-minute codes. Medicare requires at least an 8-minute session to bill a 15-minute code.
For example, if a session runs 20 minutes, you may bill only one 15-minute code—because although you have surpassed 15 minutes, you have not reached the minimum of eight minutes required for the second 15-minute code.
Medicare publishes the following guide for reporting 15-minute units:
  • 1 unit: 8 minutes to less than 23 minutes.

  • 2 units: 23 minutes to less than 38 minutes.

  • 3 units: 38 minutes to less than 53 minutes.

  • 4 units: 53 minutes to less than 68 minutes.

  • 5 units: 68 minutes to less than 83 minutes.

  • 6 units: 83 minutes to less than 98 minutes.

Medicare has a list of Medically Unlikely Edits (MUEs), which determines the maximum number of billable units for each CPT code. Many other payers may follow Medicare MUEs or have their own similar list. Separate lists exist containing Medicare’s MUEs for audiologists and MUEs for SLPs.
Does time factor into untimed codes?
Although untimed codes do not include time units in their descriptors, underlying times associated with each CPT code have been used to determine the value of the evaluation or treatment. For example, CPT code 92507 has a total underlying time of 60 minutes, and CPT code 92557 has a total time of 28 minutes. These times are based on American Medical Association surveys of audiologists and speech-language pathologists that are conducted in conjunction with ASHA and other related specialty societies.
The time associated with each CPT code includes pre-service time (before you see the patient), intra-service time (one-to-one evaluation or treatment with the patient), and post-service time (after the evaluation or treatment service has been completed). Pre- and post-service times generally include time spent reviewing records, preparing for the session, discussion of results with the patient and family/caregivers, report writing, and communicating with other health care providers. Because these activities are included in the value of each code, they generally cannot be billed separately with additional codes.
Underlying times for all codes are available in the Physician Time File, updated annually on the Centers for Medicare and Medicaid Services website.

Although untimed codes do not include time units in their descriptors, underlying times associated with each CPT code have been used to determine the value of the evaluation or treatment.

Do these underlying times mean I must follow the 51-percent rule to report untimed codes?
No. There are no rules regarding the length of billed session-based codes. However, these underlying times can serve as a guide or advocacy tool when a clinician is feeling pressure to shorten session lengths to maximize time and payment.
These underlying times come from surveys of audiologists and SLPs based on a “typical” patient. They are not meant to be prescriptive, as they may not reflect the needs of individual patients. Therefore, the underlying times do not replace clinical decision-making about the appropriate amount of time to spend with a patient.
ASHA does not recommend that clinicians base sessions on a prescribed amount of time, as each session should be individualized to the patient’s needs. How much time and what process a clinician uses to evaluate or treat a patient should be based on the clinician’s knowledge and skills and should be aligned with the patient’s goals as outlined in the plan of care.
For example, a given CPT code has an underlying time of 60 minutes, which would be considered “typical” based on clinicians who regularly provide the service. However, a clinician could determine that 30–45 minutes may be appropriate for one patient, and 90 minutes may be appropriate for another. Untimed codes, therefore, allow a certain amount of flexibility—within reason—to spend more time with some patients and less with others.
Underlying times may also help clinicians determine if they should bill a CPT code when a session is substantially shorter than the underlying time. Clinicians may need to consider submitting a claim at a reduced amount for the shortened procedure or not billing the service at all. If an exceptionally shortened service is billed, documentation should describe the clinical reason and demonstrate the benefit to the patient.
How do clinicians indicate sessions that are exceptionally long or short?
CPT has modifiers to indicate time extremes, but they may be used only for untimed codes. Modifiers may not be used to bypass time requirements associated with timed codes.
Modifiers -52 (shortened procedure) or -22 (increased procedure) can be added to an untimed CPT code to indicate that the session was unusually short or long. However, these modifiers should be used only for exceptional cases with documented clinical reason for the shortened or increased service.
Using -22 will typically be flagged for manual review by payers, and clinicians should include a rationale for the increased payment with the claim and include a suggested dollar amount. The payer may adjust the reimbursement accordingly, or not at all.
Clinicians should use modifiers sparingly, as they are meant to reflect exceptions. Modifiers should not change the original intent of the CPT code. For example, clinicians should not report a screening by reporting an evaluation code with the appended modifier -52.
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March 2018
Volume 23, Issue 3