Pediatric Coding Alert

Question: What are the guidelines for T1013? We have an in-house certified interpreter, but I’m not sure whether we can bill for a unit if the interpreter spent less than 15 minutes. I found some guidance that suggests we can report as few as 8 minutes. Is this true?

Oregon Subscriber

Answer: Technically speaking, a unit is any amount of time up to 15 minutes. That being said, a payer’s interpretation of that language is at their discretion. The usual rule of thumb for time-based CPT^® codes is the halfway point of the specified time must be exceeded to bill the code, hence the 8-minute guidance you referenced. Even though T1013 (Sign language or oral interpretive services, per 15 minutes) is a HCPCS code, it’s possible payers who reimburse this code might go by CPT^® rules on that.

Note: HCPCS T codes were established for state medical agencies (i.e., Medicaid purposes). Other payers can recognize and pay for these codes, including T1013, but whether a payer does so depends on the payer.

Another thing to remember is that civil rights law prohibits practices and other healthcare entities from charging patients for interpreter services. For this reason, many payers do not pay for T1013. Some might, however, depending on payer policy as previously stated.