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Issue Number - Name
0060 - Excessive Units - Untimed Therapy
Review Type
Automated
Claim Type
Outpatient Hospital, Part B Professional Services, Outpatient Non-Hospital Facility, Skilled Nursing Facility (SNF), Outpatient Rehab Facility (ORF), Comprehensive Outpatient Rehab Facility (CORF), Physician and Non-Physician Practitioner/ Provider Specialty,
Region and State
RAC 1-4
All States
Date Approved
2017-09-06

Description

When reporting service units for untimed codes, excluding modifiers KX and 59, where the procedure is not defined by a specific timeframe, the provider should enter a "1" in the units bill column per date of service.

Affected Code(s)

  • 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92597, 92609, 97001, 97002, 97003, 97004, 97012, 97016, 97018, 97022, 97024, 97028, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, G0281, G0283, G0329

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833(e)
  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A)
  • CMS Pub 100-04, Medicare Claims Processing Manual, Chapter 5, Section 20.2
  • American Medical Association, Current Procedure Terminology 2014 to current
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 5, Sections 10, 20, 30, 40 and 100
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Sections 220 and 230
  • CMS Pub. 100-04, Medicare Claims Processing Manual, CR 9698 December 1, 2016 (Transmittal 3670)