Home Health — How to Calculate Home Health Units

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Q: (Home Health) — “I have come across conflicting information for Home Health. Each unit is 15 minutes but are the units rounded based on the time?”

A: Yes. CPT unfortunately is not consistent with time. You need to look at the references in the guidelines if they give it to you. If not, you need to consult CPT Assistant. I don’t know this answer off the top of my head, but I do know that it’s not a pat answer. And the reason why, you would think, “Well, it’s the same publisher,” but they have different committees that are working on different areas of CPT. So, one committee interprets, “OK, well 15 minutes…” like when I used to be an occupational therapist and we did billing for PT and OT, if it was over 8 minutes of the 15 minutes then they would let you count another unit of that service. That was for that specialty, but then there are areas in CPT where it says, “No. If it’s extra 30 minutes, it has to be a full 30 minutes before you could code that add-on code.”

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So, I would look in the CPT Assistant reference and that’s basically a little sister publication to the CPT manual that the AMA puts out to help explain areas of coding that need some more guidance.

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