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Question: We recently saw a patient for a nutrition therapy counseling session. The session began at 3:00 PM and ended at 3:52. Can we bill for a full hour, or 97802 x 4, for this encounter?

Codify Subscriber

Answer: As its descriptor states, 97802 (Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes) is a time-based code. Per the descriptor, you would bill in increments of 15 minutes.

As the session you describe lasted for 52 minutes, you will not be able to bill for a full hour, or for the four units that you suggest in your question. This is because of established CPT^® guidelines, which state, "A unit of time is attained when the midpoint is passed." That means, for a timed CPT^® code measured in 15-minute units, like 90782, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. Because 52 minutes is only 7 minutes longer than 45 minutes, a fourth unit of 97802 has not been achieved.

Using this formula, Medicare and payers that follow CPT^® guidelines would regard four 15-minute units as a period between 53 minutes through 67 minutes. Three 15-minute units, however, are regarded as a period between 38 minutes through 52 minutes (See the Medicare Claims Processing Manual, 20.2.C, found at ).

So, as this session did not meet the threshold of 53 minutes, you would bill 97802 x 3.  

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