8-Minute Rule Therapy: How Does it Works, Rules, Chart and Billing
by BillingFreedom | Apr 17, 2024
8-Minute Rule Therapy: It’s helpful to be familiar with terms such as the “8-minute rule” to understand how beneficiaries are charged for medical services.
Sometimes, errors occur because some healthcare providers have a limited understanding of the 8-minute rule therapy, which can result in delayed reimbursement or underbilling for providers.
What is the 8-Minute Rule?
To receive payment from Medicare for a time-based (or constant attendance) CPT code, a therapist must provide direct treatment for at least eight minutes, known as the 8-minute rule. Providers can add the total minutes of skilled, one-to-one therapy and divide that total by 15 to determine the number of billable units for a service date. According to the rule, if eight or more minutes remain, you can bill one or more units. Otherwise, you cannot.
Medicare 8-Minute Rule
The 8-Minute Rule was introduced in December 1999 and became effective in the United States on April 1, 2000. It is a stipulation that applies to time-based CPT codes for outpatient services and allows the practitioners to bill Medicare for one unit of service if its length is eight or more minutes but less than 22 minutes.
What are time-based CPT codes?
Time-based codes allow providers to bill variably in 15-minute increments. These CPT codes differ from service-based codes, which physicians can only bill once regardless of how long they spend while providing a particular treatment to patients.
How does this 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 rule to apply. Medicare will be billed based on the total time per discipline upon receiving more than one service from the provider. However, Medicare will not be billed if an individual service takes less than eight minutes.
What are time-based CPT codes?
On the other hand, time-based codes allow for variable billing in 15-minute increments to use codes for performing one-on-one services. These codes include:
- therapeutic exercise (97110)
- neuromuscular re-education (97112)
- gait training (97116)
- therapeutic activities (97530)
- manual therapy (97140)
- electrical stimulation (manual) (97032)
- iontophoresis (97033)
- ultrasound (97035)
Reference Chart
Here is a quick reference chart of the 8-Minute Rule.
| Time | Units |
|---|---|
| 8 – 22 minutes | 1 unit |
| 23 – 37 minutes | 2 units |
| 38 – 52 minutes | 3 units |
| 53 – 67 minutes | 4 units |
| 68 – 82 minutes | 5 units |
| 83 minutes | 6 units |
8-Minute Rule Example
Let’s take the example of a doctor who performed 30 minutes of therapeutic exercise (EX), 15 minutes of manual therapy (MT), 8 minutes of ultrasound (US), and 15 minutes of unattended electrical stimulation (ESUN) on a particular date. To accurately charge according to the 8-minute rule, you would add the constant attendance procedures:
30 min + 15 min + 8 min = 53 direct timed minutes. This supports four billing units.
In addition, the 15 minutes of ESUN support one additional service-based billing unit for a total of five units for this date of service.
The Rule of Eights
From a technical point of view, it is a slight variant of CMS’s 8-Minute Rule, found in the CPT code manual and sometimes referred to as the AMA 8-Minute Rule. The difference is that it still counts billable units in 15-minute increments, but instead of combining the time from multiple units, the rule is applied separately to each unique timed service. For this reason, math is also applied separately. It is important to note that the rule of eights only applies to timed codes with 15 minutes listed as the “usual time” in the operational definition of the code.
Let’s take the example of a therapist who bills 10 minutes of 97110 and 10 minutes of 98116 per visit. As these codes are considered unique services and are counted separately, the therapist can bill for two units, 97110 and 98116, if the service lasted longer than eight minutes.
Assessment and Management Time
Sometimes, therapists make the mistake of omitting assessment and management time when counting billable minutes to submit claims for reimbursements. However, CPT codes make allowances for assessment and management time, and that time includes all the things you have to do to deliver an intervention, which includes:
- assessment of the beneficiary before performing a hands-on intervention
- assessment of the beneficiary’s response to the intervention
- counseling regarding at-home self-care
- answering beneficiary’s or caregiver’s questions
- documenting in the beneficiary’s presence
The physician’s documentation is the appropriate place to justify the decision to bill for assessment and management time. Payers will likely greenlight the extra minutes if the documentation accurately describes the treatment and another provider can understand it quickly.
How to avoid 8-Minute Rule mistakes?
The 8-minute rule contains some tricky scenarios that can negatively affect billing. Providers and billers can leave long division to an EMR with built-in 8-minute rule functionality to ensure accurate billing calculations.
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