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Time and Procedure Based

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Below demonstrates individual service rates based on time. Each rate is the same, but each rate line uses a different procedure code.

Details

  • The rate is associated to two plans/contracts.
  • The time chart used allows for partial units. For example, if the service entered has a duration of 00:30, the unit total would equal .5 of a unit, which will be used in the calculation.
  • The rate details say the following... "Effective 09/01/1995, for clients who are between the ages of 0 and 98, our agency's normal rate for the service is $90 per one full unit. The procedure codes on the claim produced will be 90804 for services that last 0 - 30 minutes, 90806 for services between 31-60 minutes, and 90808 for any service that lasts longer than an hour."
  • A duration on the service entered as 45 minutes would equal .75 of a unit. The system will use 90.00 X .75 as the calculation and the procedure code would be 90806.

 

 

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