Physical Medicine & Rehabilitation: Maximum Combined Frequency Per Day Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
This policy describes reimbursement for Physical Medicine and Rehabilitation Therapy CPT/HCPCS codes containing a time element. These services are referred to as “timed codes” within the policy. Note: In alignment with the Centers for Medicare and Medicaid Services (CMS), at least eight minutes of therapy services must be performed to meet the minimum time qualification to bill one 15 minute unit.The purpose of this policy is to ensure that UnitedHealthcare reimburses Physicians and Other Qualified Health Care Professionals for physical medicine and rehabilitation therapy services that are coded properly in accordance with CMS and CPT/HCPCS Coding Guidelines, as well as, all applicable reimbursement policies, member benefits and provider contracts.
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Click to Download: Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy, Professional (1/1/2020)
Questions and Answers
Q: Why are services provided in the home or in rehabilitation center settings excluded from this policy?
A: There are many contracts and billing methods specific to these health care professionals and facilities that permit or require codes to be used in a different manner than they would be used in an outpatient or office setting, which would affect the application of this policy. For this reason, these settings are excluded from this policy.
Q: How was the reimbursement parameter of four timed codes per specialty, per date of service determined?
A: This reimbursement parameter was derived from a study of CMS Local Coverage Determinations. A majority of jurisdictions that have Physical Medicine and Rehabilitation LCDs have guidelines indicating that the usual treatment session does not exceed 60 minutes, per specialty, per date of service.