Highmark Blue Cross Blue Shield will adopt Medicare’s method on counting minutes for timed therapy codes. Please reference claims processing publication 100-04 from CMS for complete details. When more than one service represented by 15-minute timed codes is performed in a single day, the total number of minutes of service (as noted in the chart below) determines the number of timed units billed. The expectation (based on the work value for these codes) is that the provider’s direct patient contact time for each unit will average 15 minutes in length. If only one service is provided in a day, providers should not bill for the services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15-minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality, or procedure in a day, is greater than or equal to 23 minutes, through and including 37 minutes, then 2 units should be billed. The pattern remains the same for treatment times in excess of the chart below.

Timed intervals for 1 through 8 units are as follows:
8 - 22 minutes 1 unit
23 - 37 minutes 2 units
38 - 52 minutes 3 units
53 - 67 minutes 4 units
68 - 82 minutes 5 units
83 – 97 minutes 6 units
98 – 112 minutes 7 units
113 – 127 minutes 8 units

Example:
18 minutes therapeutic exercise (97110)
13 minutes of manual therapy (97140)
10 minutes of gait training (97116)
8 minutes of ultrasound (97035)
49 Total timed minutes

Appropriate billing is for 3 units. Bill the procedures you spent the most time providing. You would have 1 unit each of 97110, 97116, and 97140. You are unable to bill for the ultrasound because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless of how many services were performed). You would still document the ultrasound in the notes.