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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3. School Health and Related Services (SHARS) : 3.5 Claims Filing and Reimbursement : 3.5.1 Claims Information : 3.5.1.2 Billing Units Based on 15 Minutes

3.5.1.2
Billing Units Based on 15 Minutes
All claims for reimbursement are based on the actual amount of billable time associated with the SHARS service. For those services for which the unit of service is 15 minutes (1 unit = 15 minutes), partial units must be rounded up or down to the nearest quarter hour.
Reminder:
Enter the number of billing units in Block 24G of the CMS‑1500 paper claim form. Claims without this information may be reimbursed as a unit of 1.
To calculate billing units, count the total number of billable minutes for the calendar day for the SHARS student, and divide by 15 to convert to billable units of service. If the total billable minutes are not divisible by 15, the minutes are converted to one unit of service if they are greater than seven and converted to 0 units of service if they are seven or fewer minutes.
For example, 68 total billable minutes/15 = 4 units + 8 minutes. Since the 8 minutes are more than 7 minutes, those 8 minutes are converted to one unit. Therefore, 68 total billable minutes = 5 units of service.
Examples:

Texas Medicaid & Healthcare Partnership
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