Does HCPCS code G0444 require a full 15 minutes, or can you use it if 8 minutes are documented?
The reason for this question is that some codes follow the CPT unit of time rule, from the front of the CPT book. And some codes require the full length of time. How do we know which is which? The CMS information about code G0444 is silent on this.
I interpret CPT and CMS time codes to use the CPT time rule that a unit of time is met when the midpoint is passed, unless either CPT or CMS says otherwise. Where would we find that? For CPT codes right in the book, in the comments underneath the code.
For CMS, it could be in their MedLearn Matters articles and guides, or in the annual Final Rules when they develop a code. For example, 99417 and G2212 both say to only use them when a full 15 minutes is met. For 99417, it states that in the CPT book, below the code. For G2212, it was in the 2021 Final Rule, when the code was developed.
There are some remote monitoring codes and CCM codes that also provide guidance in the CPT book. Let’s look at 99457. This is remote physiological monitoring treatment…. during the month, first 20 minutes. Under code 99457 it says,
“Do not report 99457 for services of less than 20 minutes.”
The add-on code is 99458. CPT says, “Do not report 99458 for services of less than an additional increment of 20 minutes.” These codes do not use the mid-point unit of time rule.
My interpretation: use the CPT time rule on page xvii unless CPT or CMS explicitly says that the full time is required. That rule is:
“A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes.)”
I wish all the codes used time the same way!
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