What is the Medicare 8-Minute Rule?
Medicare’s 8-minute rule is a stipulation that applies to time-based CPT codes for outpatient services, such as physical therapy. Introduced in December 1999, the 8-minute rule became effective on April 1, 2000. The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable ‘unit’ of service refers to the time interval for the service. Under the 8-minute rule, units of service consist of 15 minutes each. The 8-minute rule is generally only applicable to Medicare patients. Other third-party payers typically use the midpoint rule where physical therapists may bill one unit for any timed procedure or modality that is performed for 8 or more minutes. The total time requirement is not considered here. You can refer this article as a guide for Medicare’s 8-minute rule for physical therapists.
How Does Medicare’s 8-Minute Rule Work?
The 8-minute rule applies only to services where the practitioner has direct contact with the patient. Therefore, the service must be in-person for the 8-minute rule to apply. If you’ve received more than one service, Medicare will be billed based on total timed minutes per discipline. If an individual service takes less than eight minutes, Medicare won’t be billed for it. The services are then billed in 15-minute units. Therefore, if a service or services take(s) 20 minutes, Medicare will be billed for one unit, because the number of minutes falls between eight and 22. If 23 to 37 minutes is spent on the service(s), Medicare can be billed for two units. If the service(s) take(s) 38 to 52 minutes, the practitioner can charge for three units, and this pattern continues (in 15-minute intervals) beyond two-hour services (see table).
CMS allows to include any time spent re-assessing the patient or teaching the patient about how to manage their problem. For example, if you are re-assessing a patient’s balance or coordination after having done some Neuromuscular Re-education techniques then you may include that time in the minutes spent doing the Neuromuscular Re-ed. The clock starts running as soon as you interact with the patient. So, if you get your patient from the waiting room and ask how they are doing (e.g. seeking their current status) and observe their gait or their movements then you have started your assessment. Likewise, if you are teaching the patient some new exercises for their home program or if you were teaching them safer movement patterns when getting out of bed you would be able to include those minutes in the Therapeutic Exercise time or the Therapeutic Activities unit time. Note that, if you are doing any documentation in front of the patient (for that patient) during your intervention work with them, you may include that in your minutes. However, you may not include any documentation time away from the patient. CMS generally states that time spent writing notes away from the patient is non-billable.
Medicare’s 8-Minute Rule
# of Billable Units
8 – 22 Minutes
23- 37 Minutes
38- 52 Minutes
53- 67 Minutes
68- 82 Minutes
83- 97 Minutes
113- 127 Minutes
Suppose 30 minutes of Therapeutic Exercises are provided, and 6 minutes of manual therapy, and 4 minutes of Therapeutic Activities which totals 40 minutes. In this case total of 3 units must be billed. You would bill 2 units of Therapeutic Exercise, but you don’t have 8 minutes of either Manual Therapy or Therapeutic Activities. CMS guidelines suggest adding these two together (equaling 10 minutes) and you may bill whichever code has more minutes provided. The 3rd unit would be billed as Manual Therapy because you provided more (6 minutes) than Therapeutic Activities (4 minutes).
The patient visits the hospital where his physical therapist’s office is located. He receives 31 minutes of therapeutic exercise and 14 minutes of manual therapy. He then goes upstairs and receives an ultrasound, which takes nine minutes. The total number of minutes between services is 54, so the patient’s Medicare plan will be billed for a total of four units of service. In this example, the ultrasound is not billed separately. Since each service takes longer than eight minutes, the minutes are added together and billed to Medicare as the total number of units.
The patient visits his physical therapist’s private practice. His physical therapist spends 16 minutes assessing his situation, 23 minutes on manual therapy, and seven minutes answering the patient’s questions. This visit totals 46 minutes, so the office will charge Medicare for three units of service.
Ensure that your documentation clearly supports the intensity level and direct one-on-one time spent on any timed codes being billed. It must also clearly match the definitions in the CPT code book for that code. The 8-minute rule is nothing to be afraid of. At times, providers are unaware of the full range of services for which they should bill, such as assessments. This results in underbilling. With a clear understanding of Medicare’s 8-minute rule for physical therapists, you can ensure that you’re not overbilling or underbilling. You deserve to be paid for the services you provide in accordance with Medicare’s rules, and we can assist you with that. Legion Healthcare Solutions is a leading medical billing company providing complete billing and coding services. We can help you in receiving timely and accurate reimbursements for your physical therapy services. To know more about our physical therapy billing services, contact us at 727-475-1834 or email us at firstname.lastname@example.org