How to calculate group and concurrent therapy minutes
Per resident, per discipline, across the stay, and what each mode does to your own numbers.
To calculate group and concurrent therapy minutes, record the full session length for each resident who took part, coded by mode: individual, concurrent or group. PDPM is the US Medicare Part A payment model for skilled nursing facilities (SNFs). Under PDPM, the two shared modes combined, called mode minutes in this guide, are limited to 25% of each resident's therapy minutes in each discipline.
The same session is counted two ways. The resident's record shows the minutes that resident received, and your employer credits you with minutes by its own method.
What counts as group and concurrent
For a US Medicare Part A stay, the modes are defined like this:
- Concurrent therapy is the treatment of 2 residents who are not doing the same or similar activities at the same time. Both must be in the line of sight of the treating therapist or assistant.
- Group therapy is the treatment of 2 to 6 residents doing the same or similar activities. The therapist or assistant supervising them is not supervising anyone else.
Under US Medicare Part B, treating 2 or more people at the same time is group therapy, and there is no concurrent category. The rest of this guide is about Part A stays under PDPM. The guide to group and concurrent therapy under PDPM covers the rules in more detail.
What gets recorded for the resident
Each resident's MDS records the full minutes of the session, coded by mode, with no splitting. A 30-minute concurrent session with two residents records 30 minutes for each of them, marked concurrent. A 45-minute group of five records 45 minutes for each, marked group.
So the two residents' records in that concurrent session add up to 60 minutes, while the session took 30 minutes of your time.
Checking the 25% limit
Mode % = (group minutes + concurrent minutes) ÷ total therapy minutes × 100
Example: a resident receives 400 minutes of OT across a stay, made up of 60 group, 40 concurrent and 300 individual.
- (60 + 40) ÷ 400 × 100 = 25%, exactly at the limit.
- One more 30-minute group session makes 430 minutes in total, 130 of them mode minutes: 130 ÷ 430 × 100 = 30.2%, over the limit.
The limit is measured over the whole Part A stay, using item O0425 on the PPS Discharge assessment. A stay with an interruption counts as one stay. Going over 25% is non-compliance and brings a non-fatal warning on the MDS Final Validation Report. There is currently no payment penalty for it.
Working out the headroom
To find the headroom, divide the resident's individual minutes by 3.
Maximum mode minutes = individual minutes ÷ 3
This follows from the limit. If mode minutes are at most a quarter of the total, the individual minutes are at least three quarters. So mode minutes are at most a third of the individual minutes. A resident with 300 individual minutes can have up to 100 mode minutes.
| Individual minutes | Maximum mode minutes | Total |
|---|---|---|
| 150 | 50 | 200 |
| 240 | 80 | 320 |
| 300 | 100 | 400 |
| 450 | 150 | 600 |
| 600 | 200 | 800 |
Residents with few total minutes reach the limit fastest, because one group session is a large share of a small total. A department that tracks the limit per therapist, or for the whole department, can miss these residents. Track it per resident, per discipline.
The Concurrent and Group Therapy Calculator does this check. Enter a resident's minutes in each mode (individual, group, concurrent) and a planned session. It shows the mode %, the headroom left and the percentage after the planned session.
Tracking the limit across a stay
Because the limit covers the whole stay, group sessions early in a stay reduce what you can do later. Check the running total before you schedule a mode session for a resident whose plan is short or whose discharge is close.
Example: a resident has 200 minutes delivered, 45 of them mode minutes. That is 22.5%. The resident has 155 individual minutes, so the maximum is 155 ÷ 3 = 51.7 mode minutes. That leaves about 7 more mode minutes in that discipline.
How the mode affects your productivity credit
The credit depends on your employer's method. Three methods you may meet:
| Method | A 45-minute group of 5 credits you | Effect |
|---|---|---|
| Session time once | 45 minutes | The same as a 45-minute individual session |
| Resident minutes | 225 minutes (45 × 5) | Credits five times the session length |
| Discounted resident minutes | Set by the employer | Somewhere between the two |
Under the resident-minutes method, one 45-minute group credits 225 minutes. That is half of a 450-minute paid day (8 hours with a 30-minute unpaid lunch, as an example). Ask which method your department uses, because it changes what your percentage means.
Productivity with groups: the setup time
A five-person group needs residents gathered, seated, equipped and taken back. Suppose that takes 25 minutes (an example). If your employer credits session time once, the 45-minute group credits 45 minutes but takes 70 minutes of your day, so your figure falls. Time your own groups for two weeks before you assume the mode helps your numbers.
Using a therapy productivity calculator with concurrent or group sessions
If you use a therapy productivity calculator with group or concurrent sessions in your day, enter the minutes your employer credits you with. Under the session-time method, a 30-minute concurrent session is 30 minutes of treatment time. Under the resident-minutes method, it is 60.
The Concurrent and Group Therapy Calculator shows both figures for a planned session. Add the figure that matches your employer's method to your treatment minutes in the therapist productivity calculator.
Documenting the mode decision
Each note should say which mode was used and why it suited that resident on that day. Identical reasons copied across every resident in a group say nothing about any one of them.
Useful reasons are clinical and specific. One is peer modeling for a resident who moves more readily alongside others. Others are graded challenge in a supervised setting, or functional practice in a social setting. "Group therapy provided" states what happened without saying why.
When staffing drives the mode
If shared sessions rise on short-staffed days and fall on fully staffed ones, the pattern shows in the department's records. The notes go out under the clinicians' names. The joint AOTA, APTA and ASHA Consensus Statement on Clinical Judgment warns about overriding clinical judgment through employer pressure to meet quotas. It says this may violate payer rules, conflict with state licensure laws and even constitute fraud.
If you are directed toward group treatment for staffing reasons, ask for the instruction in writing. That gives you a record of who made the decision.
A checklist before you schedule a mode session
- Does this resident have headroom under the 25% limit in this discipline?
- Is there a clinical reason for the mode that you can state in one sentence?
- Does the group's makeup make clinical sense, or is it whoever was available?
- Have you allowed for the time to gather and return residents?
- Will each resident get an individual note that explains the mode for them?
This guide is general information about US Medicare rules. It is not billing, coding, legal or employment advice. Your employer's and payer's rules, and the current MDS manual, decide.