PT/OT/ST Billing Guidelines Consistent with CMS "Total Time" Approach

Date: 03/07/18

Heritage Health (Medicaid):

Nebraska Total Care follows CMS billing guidelines for therapy services in Nebraska and across the country, which is to bill for "total time" spent with the patient by provider discipline (PT/OT/ST) at the time of service as opposed to the amount of time spent on each modality. For full CMS guidance and billing examples, please refer to Counting Minutes for Timed Codes in 15 Minute Units (PDF).

HPB 11-22 from 2011, which previously spoke to billing by modality for Fee-for-Service Medicaid, was superseded by HPB 16-01 in 2016 and is no longer applicable.

Nebraska Total Care's approach is consistent with national billing guidelines.

For more information on how to bill based on total time spent with the patient, please refer to instructions on Counting Minutes of Service Units (PDF). CMS provides additional guidance on the CMS website.

If you have additional questions, please contact your Provider Relations representative.