Timed services: pool direct treatment minutes using the CMS 8-minute rule. Allocate full 15-minute blocks first, then remaining units to the service with the most remaining minutes. Ties may go to either service.
8–22 min 1 unit23–37 min 2 units38–52 min 3 units53–67 min 4 units
Untimed services: evaluations and group therapy use one unit. Their minutes count toward session length, but not the timed-code pool. Evaluation code selection depends on complexity, not session length.
Payment model: national non-facility CMS physician fee schedule, non-QP conversion factor, and geographic factors of 1.0. The estimate applies the therapy multiple procedure payment reduction (MPPR): full practice expense for the highest eligible unit, 50% practice expense for other eligible units. Work and malpractice components are not reduced.
“Fee collected” and “total payment” are simulated allowed amounts, including payer and patient responsibility together. Actual collections, coverage, deductibles, coinsurance, geographic adjustments, CO assistant reductions, sequestration, and other claim edits are not modeled. Student status alone does not establish a CO modifier.
TennCare and private insurance use the same CMS benchmark for this exercise; it is not their contracted rate or a statement of their timing policy. Calculations assume this is the only therapy encounter for this client on that calendar date. Real same-day services may need to be combined. Code suitability, NCCI edits, supervision, and coverage need instructor review.
CMS therapy billing manual · TennCare fee schedule contacts
CPT is a registered trademark of the American Medical Association. Code labels here are abbreviated educational labels. Fee calculations are derived from CMS data. This tool covers 23 commonly used services, not the complete CPT code set.