What Is Medicare’s 8 Minutes Rule, and How Does It Work?
If you do not understand some basics of Medicare’s 8-Minute rule, sometimes known as the “Rule of Eights,” it can become challenging. Fortunately, we have gathered all the information to help you understand this rule, its concept, and its use in Medicare. Explore the essentials of Medicare 8 Minute Rule. Learn how it affects time-based CPT codes in outpatient therapy and ensures accurate Medicare billing. Essential guide for therapists and healthcare professionals.
The Fundamentals of the 8-Minute Rule
The 8-Minute rule controls how rehab therapists decide how many units they should charge to Medicare for outpatient therapy services provided on a specific date. To be reimbursed for a time-based treatment code, a therapist must perform direct, one-on-one therapy for at least eight minutes.
What Exactly Is the 8-Minute Rule?
Medicare’s 8-minute rule states that you can bill Medicare for one entire unit if a service takes between 8 and 22 minutes. As a result, this can only apply to CPT codes that are time-based. The 8-minute guideline, however, does not apply to all time-based CPT codes or all situations.
This rule does not apply to other insurance companies unless they have specified that they follow Medicare billing guidelines. You will need to make sure you are billing according to your agreement with payers who do not meet Medicaid’s requirements.
How Does It Work?
“To bill one unit of a timed CPT code, you must execute the corresponding modality for at least 8 minutes,” according to this WebPT page. To put it another way, Medicare adds up all of the minutes of professional, one-on-one therapy (direct time) and divides the total by 15. You can bill for an additional unit if there are eight or more minutes left over. However, if you only have seven minutes left, Medicare would not compensate you for another entire unit, so you will have to forego the rest.
What Is a Timed Code?
In the AMA CPT codebook, time-based codes are described as services provided one-on-one in 15-minute blocks of time, e.g., To 1 unit = 15 minutes. When assessing the number of units billed for a visit, the 8-minute rule comes into play.
What Are CPT Time-Based Codes?
Variable billing in 15-minute increments is possible using time-based codes. These codes provide one-on-one services such as:
- Therapeutic exercise (97110)
- Teuromuscular re-education (97112)
- Therapeutic activities (97530)
- Electrical stimulation (manual) (97032)
- Gait training (97116)
- Ultrasound (97035)
- Manual therapy (97140)
- Iontophoresis (97033)
What Is an Untimed Code?
Untimed codes, also known as service-based CPT codes, have no time restriction in their definition and are usually given to a patient once per day. Physical Therapy Evaluation (97161), Mechanical Traction (97012), or Electrical Stim, unsupervised are examples of these codes (97014). These codes are in one unit, regardless of how long they perform on the patient. These codes are one unit but are not included in the totaling of the timed code units because there is no timed component.
Why Is It Known as the “8-Minute Rule”?
Suppose a treatment does not fit cleanly into 15-minute intervals. As a result, CMS will allow only 8 minutes to be counted as a billable unit.
Consider 8 minutes to be the tipping moment. The 15-minute block counts as a unit once you have crossed the 8-minute mark!
You will “satisfy” the bulk of the 15-minute time block required to bill for one unit by spending 8 minutes with your patient.
Bottom Line
We hope that the following information clears up any misunderstandings you may have about the 8-minute rule. There is nothing that you should be afraid of when it comes to Medicare’s 8-minute rule. You can avoid overbilling or underbilling by having explicit knowledge of what the rule implies. New Medicare may assist you with Medicare compliance by providing built-in solutions to help you stay on track.
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