CMS Pub. 100-04, ch. 4, § 20.4

The definition of service units (FL 46 on the Form CMS-1450) where HCPCS code

reporting is required is the number of times the service or procedure being reported was

performed.

EXAMPLES:

If the following codes are performed once on a specific date of service, the entry in the

service units field is as follows:

HCPCS Code Service Units

90849 - Multiple-family group psychotherapy Units > 1

HCPCS Code Service Units

92265 - Needle oculoelectromyography, one or more

extraocular muscles, one or both eyes, with

interpretation and report

Units > 1

95004 - Percutaneous tests (scratch, puncture, prick)

with allergenic extracts, immediate type reaction,

specify number of tests.

Units = no. of tests performed

95861 - Needle electromyography two extremities

with or without related paraspinal areas

Units > 1

6 Units > 83 min. to < 98 min.

7 Units > 98 min. to < 113

min.

8 Units > 113 min. to < 128

min.

The pattern remains the same for treatment times in excess of two hours. Hospitals

should not bill for services performed for less than eight minutes. The expectation (based

on the work values for these codes) is that a provider’s time for each unit will average 15

minutes in length. If hospitals have a practice of billing less than 15 minutes for a unit,

their A/B MAC (A) will highlight these situations for review.

The above schedule of times is intended to provide assistance in rounding time into 15-minute increments. It does not imply that any minute until the eighth should be excluded

from the total count as the timing of active treatment counted includes time.

The beginning and ending time of the treatment should be recorded in the patient’s

medical record along with the note describing the treatment. (The total length of the

treatment to the minute could be recorded instead.) If more than one CPT code is billed

during a calendar day, then the total number of units that can be billed is constrained by

the total treatment time. For example, if 24 minutes of code 97112 and 23 minutes of

code 97110 were furnished, then the total treatment time was 47 minutes; so only 3 units

can be billed for the treatment. The correct coding is two units of code 97112 and one

unit of code 97110, assigning more units to the service that took more time.