Defining One-on-One Therapy for Medicare Patients – Part 2

Please note that this article contains information that is only relevant to American clinics.


In Part 1 of this series, we set out to define one-on-one therapy. The reason for doing so was because many therapists were under the impression that they couldn’t see more than one Medicare patients at the same time. This was proven to be false. In Part 2, we’ll be discussing some of the scenarios in which you can see more than one Medicare patient at the same time.


Have you read Part 1 of this series about one-on-one therapy for Medicare patients? Click here to access it.


As noted in Part 1, ‘Therapeutic Procedures’ and the ‘Constant Attendance’ modality require direct one-on-one contact with a therapist. These types of treatments are classified as ‘time-based CPT codes’. And unless the patient has your complete and undivided attention, you cannot bill two of these CPT codes within the same timeframe.


In situations where you wish to bill two patients within the same 15-minute window, you must ensure that only one of your charges includes a time-based CPT code. A recent article published by Gawenda Seminars and Consulting has provided us with some insight on how you can book multiple patients at the same time.


Their article stated that “What you can bill during the same 15 minute period is 1 unit of a 15-minute time-based CPT code and a supervised modality–since the supervised modality a service-based CPT code and not time-based.” The article goes on to explain that when the patient is receiving a supervised modality, like an unattended electrical stimulation, you’re essentially being paid for providing the patient with access to the to the equipment. This does not necessarily involve one-on-one attention.


Hint: Have you heard about the CPT Assistant? You can subscribe to this newsletter published by the American Medical Association (AMA) for the most up-to-date information about the correct use of CPT codes.


We hope that you found this article helpful. For more content like this, check out the Gawenda Seminars and Consulting website and learn about the benefits of becoming a Gold Member.

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