June 10, 2024

Substantial Portion Methodology in Physical Therapy Billing

Introduction to SPM in Physical Therapy

Substantial Portion Methodology (SPM) stands out as a critical technique for practice owners and therapy professionals seeking to optimize their billing processes. SPM, often juxtaposed with the commonly known 8-minute rule, requires a deep understanding to ensure that practices are not only compliant with various payer guidelines but also capitalizing on potential revenue opportunities. This article delves into the nuances of SPM, offering comprehensive insights into how it can be effectively utilized in physical therapy settings.

What is Substantial Portion Methodology (SPM)?

Substantial Portion Methodology (SPM) is a billing practice that predates the Medicare 8-minute rule and is primarily used by commercial insurance providers. Unlike the Total Minute Rule that aggregates time spent on various services, SPM focuses on the time allocated to each specific Current Procedural Terminology (CPT) code during a patient’s treatment session.

Key Aspects of SPM in Physical Therapy

SPM requires that a substantial portion of a timed service—typically more than half of the allotted time segment—be dedicated to the direct delivery of the therapy service specified by a CPT code. For instance, for a 15-minute therapy service, at least 8 minutes must be spent directly providing that specific therapy to bill one unit under SPM.

How SPM Billing Works

In SPM, each unique service provided to a patient can potentially be billed if it crosses the minimum time threshold defined by the SPM criteria. This methodology allows therapists to bill multiple units for multiple services provided within a single visit, as long as each service meets the time requirements. This aspect of SPM can lead to increased revenue potential as more services per session can be charged under SPM compared to other billing methodologies that might consolidate service times.

SPM Charges and ComplianceAn image of a physical therapy session with a therapist working directly with a patient, focusing on delivering specific therapy services, with detail-4

Documentation and Compliance

SPM billing demands meticulous documentation to support the charges applied. Each service billed must have clear and detailed notes that justify the session length and the service provided. This rigorous documentation is crucial not only for compliance with insurance requirements but also for defending against audits.

Insurance Considerations and SPM

Not all insurance carriers accept SPM, and among those that do, the specifics can vary significantly. While Medicare strictly adheres to the 8-minute rule, commercial payers such as Blue Cross Blue Shield, Aetna, and Cigna may allow SPM. It’s essential for practice owners to thoroughly understand the payer contracts to determine whether SPM is acceptable and under what circumstances.


Advantages of SPM

Enhanced Revenue Opportunities

One of the primary benefits of SPM is the potential for higher revenue. By enabling the billing of multiple units per visit, SPM can significantly increase the total charges per patient session. This is particularly advantageous in a busy clinic where therapists provide multiple distinct treatments.

Flexibility in Service Provision

SPM offers more flexibility in how services are structured and billed, allowing therapists to tailor their sessions to the specific needs of their patients without being overly constrained by billing limitations.

Challenges of Implementing SPM

Learning Curve and Training

Implementing SPM can be challenging, especially for practices accustomed to the simpler Total Minute Rule. Training and continuous education are necessary to ensure that all staff members understand how to apply SPM correctly.

Increased Administrative Burden

The need for detailed documentation and the complexity of managing multiple payer requirements can increase the administrative burden on practice staff. This can require additional resources or sophisticated practice management software to handle effectively.


An image of a physical therapy session with a therapist working directly with a patient, focusing on delivering specific therapy services, with detail-Jun-24-2024-11-54-59-8180-AM

SPM Paperwork and Documentation Best Practices

To ensure compliance and maximize billing efficiency under SPM, practices should:

  • Maintain detailed session notes that clearly describe the time spent on each service.
  • Use software solutions that support detailed time tracking and reporting.
  • Regularly train staff on the latest billing rules and documentation requirements.

Leveraging Technology for Compliance: PtEverywhere's Role in SPM Billing

Maintaining compliance with payer requirements is crucial but challenging. This is where physical therapy software like PtEverywhere steps in, offering robust tools designed to simplify and secure the process. Here’s how PtEverywhere enhances audit readiness:

  • Precise Documentation: PtEverywhere ensures that every therapy session is documented with precision, meeting the rigorous demands of SPM.
  • Detailed Time Tracking: The software's time tracking features allow for accurate recording of each service provided, essential for SPM compliance.
  • Service Documentation: Each session's details are thoroughly documented, supporting the justification needed for SPM charges.
  • Audit Risk Mitigation: By keeping organized and clear records, PtEverywhere significantly reduces the risks associated with insurance audits.
  • Compliance Ease: The platform helps maintain compliance effortlessly, ensuring practices can withstand external scrutiny without stress.

Conclusion: Is SPM Out or Still Relevant?

Despite the complexities and administrative demands, SPM is far from being phased out in the realm of physical therapy billing. For practices willing to invest in the necessary training and systems, SPM can lead to more accurate billing, improved revenue, and ultimately, better alignment of billing practices with patient care. As part of a comprehensive billing strategy, SPM not only remains relevant but also crucial for the financial health and operational efficiency of modern physical therapy practices.

Incorporating SPM into your practice through platforms like PtEverywhere can streamline the process, ensuring that your billing is both efficient and compliant, thus safeguarding your practice’s revenue and reputation.