Question: In regards to billing for attended and unattended Modalities under Med A in SNF. Under the new regulations effective October 1, 2011, do we continue to bill attended and unattended modalities as non time sensitive services?
Answer: Supervised modalities such as e-stim have skilled and non-skilled components as far as Part A is concerned. The time spent in determining the appropriate placement of the electrodes, application of the electrodes and determining of the appropriate intensity is skilled. Once the intensity of application is achieved, the time spent receiving the treatment is non-skilled as it does not need the direct attendance of the therapist. So the initial time can be counted as individual minutes and the rest is non-skilled meaning you can provide direct treatment to a second patient as individual minutes.

Attended modalities such as ultra-sound are considered all skilled time as the therapist must be physically present applying the ultra-sound. So here the assessment of the appropriate intensity of the US, based on the information provided by the patient, inspection of the area prior to application and the time spent in applying that modality is all skilled time and is included as individual time.

This interpretation actually goes along with the Part B payment as we are paid for the modality, a single flat fee regardless of the time or number of applications.