CurrentMolina HealthcarePolicy N/A

Physical therapy billing unit and reimbursement policy

Governs billing unit calculation, documentation, and reimbursement expectations for physical therapy services provided to Molina Healthcare members, affecting Molina network providers (state-level exceptions noted).

Policy Summary

PayerMolina Healthcare

PolicyPhysical therapy billing unit and reimbursement policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 23, 2023

Next Review DateN/A

Key ActionMaintain accurate documentation of exact start and stop times for direct patient contact; Molina may audit claims and recover overpayments for inconsistent sub-15-minute billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

15-minbilling unit basis

8-22=1time→unit example

start/stopdocumentation

auditclaim review

Unit determination and Documentation Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Unit determination and documentation criteria

Covered when ALL of the following documentation and unit-determination rules are met:

Determine units using 15-minute timed increments; each 15-minute increment equals one unit (e.g., 15 minutes = 1 unit; 30 minutes = 2 units).

When multiple 15-minute timed services are provided on the same calendar day, the total number of minutes of direct patient contact determines the number of timed units billed, except as noted below.

Do not aggregate time from separate services into a single code's units if any individual service exceeded 15 minutes; the aggregate time still determines total units across codes but not to inflate a single service code's units.

Short-duration services (each ≤ 7 minutes) rendered the same day: if two such services have a combined time ≥ 8 minutes, bill one unit for the longer service; this rule extends to three or more services rendered for ≤ 7 minutes each.

Use the following time-to-units mapping to convert total direct care minutes into billed units: 0–7 minutes = 0 units; 8–22 = 1 unit; 23–37 = 2 units; 38–52 = 3 units; 53–67 = 4 units; 68–82 = 5 units; 83–97 = 6 units; 98–112 = 7 units; 113–127 = 8 units (pattern continues for longer durations).

Document exact start and stop times for each timed service to support units billed, in accordance with Medicare Claims Processing Manual, Chapter 5, Section 20.2.

Maintain accurate documentation of medical necessity and appropriate diagnosis codes; lack of supporting documentation or incorrect diagnosis codes may result in exclusion from payment or claim denial.

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Timed Therapy CPT Codes and Time-to-Unit Mapping

Timed therapy CPT codesCPTCovered

15-minute timed CPT codes

Therapy services billed in 15-minute timed CPT code increments

Time-to-units mapping — 15-minute increments

0-7 minutes0 units

8-22 minutes1 unit

23-37 minutes2 units

38-52 minutes3 units

53-67 minutes4 units

68-82 minutes5 units

83-97 minutes6 units

98-112 minutes7 units

113-127 minutes8 units

Documentation, Audit, and Billing Expectations

Documentation Required

Document direct patient contact time; risk of audit and recoupment

Maintain precise records of direct patient contact time for each billed unit. Molina expects each unit to average 15 minutes, and a consistent practice of billing units representing less than 15 minutes may prompt Molina to review billing practices, audit claims, and recover overpayments identified as paid in error.

Record exact start and stop times for services to support units billed.
Be aware that repeated billing of units for <15 minutes can trigger claim review.
Molina may audit claims and recover overpayments found during reviews.

Terms and Abbreviations

Service — definition

Service (definition)A distinct physical therapy intervention represented by a 15-minute timed CPT code.

Unit basisBilling units are based on 15-minute timed CPT code intervals.

ApplicationEach discrete service of at least 15 minutes on a single calendar day is billed as one unit.

Abbreviations

CMSCenters for Medicare & Medicaid Services

CPTCurrent Procedural Terminology

OTOccupational Therapy

PTPhysical Therapy