Unit Billing – Ask a Biller Episode 7

Written by Phillip Ziff on August 9, 2018
Ask a Biller Episode 7: Unit BIlling


In Ask A Biller Episode 7, Dylan and Maggie answer all of your questions about unit billing (or billing for an appointment in multiple units). See the full episode above, transcript and slides below.

See the full transcript here (scroll to read):

MAGGIE: Hi there, thanks for tuning into Ask A Biller. I’m Maggie

DYLAN: And I’m Dylan from SmartBilling Pro at SimplePractice

MAGGIE: We put together this special episode to highlight a new feature that we’re really excited to roll out.. Unit Billing!

DYLAN: This is something that a lot of our customers have been asking for and we’re thrilled to be able to bring it to you, as it opens up our platform to new specialties such as dieticians, speech language pathologist, chiropractors, physical therapists, and occupational therapists!

MAGGIE: This new feature will give you the flexibility to bill in units rather than just by service. This feature also allows you to add multiple service codes to the same appointment without having to create multiple appointments. Even if these changes don’t affect your practice directly, this is exciting because it provides new opportunities to refer friends from different specialties!

DYLAN: Remember that when someone signs up for a paid account using your referral code, you both get a $50 credit in your SimplePractice account, and this offer is unlimited.

MAGGIE: The first thing we’re going to address is what is unit billing and why are we excited to have it?

Every type of medical service in the US has a CPT code attached to it.

CPT codes are either service based or time based

DYLAN: Service based, also known as untimed codes, are for services where the code defines what was done, such as 90834, which represents 45 minutes of psychotherapy. With these types of codes you will only ever bill 1 unit because the code captures the complete service.

Service based codes are primarily for office visits, facility charges, or tangible items. If you’re a mental health provider, you likely will only ever use service based codes.

MAGGIE: The other types of CPT codes are time-based codes. These are codes that you use for services that are usually one-on-one, and require constant attendance. For example, testing, therapeutic services, or activities. 95831 is an example of a time-based CPT code commonly used by occupational and physical therapists that represents muscle testing. One way to bill this would be $20 fee for every 10 minutes

DYLAN: Per Medicare standards, time-based codes can be billed in multiple 15-minute increments. 1 unit=15 minutes.

This chart breaks down how much the time spent on the service is worth in units.

MAGGIE: In some cases your treatment time for these codes won’t always divide into 15-minute blocks. Let’s say you only provided 14 minutes of continuous therapy. Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes.

DYLAN: Medicare will take the total sum of units billed and divide it by 15– if the amount of units remaining is 8 or more, you can bill another unit. If the amount is less than 8, you will not be reimbursed for a full unit and you will need to drop the remainder.

MAGGIE: Now that we’ve given you a little bit of background on when to use unit billing and some of the rules, we want to walk you through how to use Unit Billing in your SimplePractice account.

DYLAN: The first thing you’ll do is go to My Account > Settings in the top right corner of your account, and then, Billing and Services on the left hand side. From here go to Services, and you will see the option to switch Unit Billing on. This will activate the feature in your account.

MAGGIE: You will now see a new Unit Billing checkbox for each service code on your Billing services page. Also, now whenever adding a new code or editing an existing one, you will see this Unit Billing checkbox
When it’s a code that you will need to bill in units, check the box and your session rate box will change to a rate per units.

DYLAN: Note that If the Rate per unit is applied to an existing service, this change will only be applied to future appointments, it won’t change any existing sessions.

MAGGIE: When you schedule a session with a time-based code you will see
The code
The number of units– which defaults to 1 unit
The Rate per unit
The Total rate fields

DYLAN: From here you can adjust the Total rate by increasing the number of units, The Rate per unit for this session, or the Total rate directly.

MAGGIE: You’ll want to double-check that you’re billing the correct units by reviewing the details after you’ve held the appointment with your client. Due to the needs of different specialties, the default is always 1 unit.

DYLAN: As an additional resource for you, we reached out to some SimplePractice users that had the chance to test unit billing before we rolled it out to everyone. We asked them to share tips for clinicians or billers just getting started with Unit Billing

MAGGIE: The first person we’ll hear from is Samara A., a Registered Dietitian Nutritionist in North Carolina. She says:

“My initial assessments are structured to be 60 minutes (4 units) and my follow-ups are structured to be 45 minutes (3 units). That makes the process pretty cut and dry. I always allot myself a few minutes after a session to make any important notes about the client session. If time ran over or under, then I always adjust this first in SP so that the units are accurate when I file insurance.”

DYLAN: Thanks Samara. Next, we hear from a practice in St Louis Missouri called Come Play that bills out of network for Occupational Therapy.

“We’ve only used billing codes that are generic to the services our occupational therapists offer, so every treatment session is billed the same way for every client. 3 units of face-to-face time and 1 unit of parent education. I know not everyone has this luxury.
We do have to make sure that we record times in our progress notes to justify how many total units we bill by so it’s never considered a fraudulent billing practice. Clinicians just record this time at the end of each session when they complete their progress note. Because we can use generic codes, this process is easily standardized.”

MAGGIE: The last piece of advice comes from Yorick Wijting’s physical therapy practice located in in our home state of California

“When setting up the various services that will be billed in units, it is best to set the time for the unit to equal the standard time of the appointment (e.g., 60 mins), even though a unit is billed in 15 min increments. This will force the correct time allocation when scheduling an appointment.”

DYLAN: Thanks to everyone that sent in tips and feedback. If you’re still confused about billing insurance, check out our concierge billing service, SmartBilling Pro, at simplepractice.com/smartbilling-pro.

MAGGIE: That’s all we have for you today! Tune in next month when we will be discussing strategies for negotiating a higher rate with the payers that you work with. Until then….
Keep it Simple!


Unit Billing Webinar slides:

Download webinar slides

Ask a Biller 7: Unit Billing Slides Download with CPT Code 95831: Muscle and range of motion testing.

Watch the rest of the series here:

Episode 1: Enrollments
Episode 2: Telehealth and Insurance
Episode 3: Verification of Benefits 
Episode 4: Client Payment Types
Episode 5: Insurance Payments
Episode 6: Out-of-Network Billing

Read more

About the Author

Phillip is the Product Marketing Manager at SimplePractice. He's an ENTP, owns over 30 board games, and can be seen around LA performing improv comedy.

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