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Time-Based Measurement Standard to Follow AMA

October 14, 2019

As of July 22, 2019, we changed our time measurement standard for billing physical medicine services. We will now follow the American Medical Association (AMA) guidelines for time-based services. These are time-based codes within the Physical Medicine and Rehabilitation section of the Current Procedural Terminology (CPT®) code book.

When billing for time-based services use the CPT codes in the AMA code book, except as required by federal law for Medicare and Medicaid patients. The AMA guidelines will apply to these physical medicine services:

97110, 97113, 97116, 97530, 97533, 97535, 97537, 97542, 97750, G0515

As always, it is critical to check eligibility and benefits first, before rendering care and services to confirm coverage, network status and other important details. When you check eligibility and benefits online by submitting an electronic 270 transaction through the Availity® Provider Portal Learn more about third-party links or your preferred web vendor portal, you may determine if benefit prior authorization may be required based on the procedure code.

Payment may be denied if you perform procedures without benefit prior authorization when benefit prior authorization is required. If this happens, you may not bill our members.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized/pre-notified for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.

BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such Availity. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.

CPT Copyright 2019 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.