8-Minute Rule Therapy: To understand how beneficiaries get charged for medical services, it’s helpful to be acquainted with terms such as the “8-minute rule”.
Sometimes errors occur because of the limited understanding of some health care providers regarding the 8-minute rule therapy, which can result in delayed reimbursement or underbilling for providers.
What is the 8-Minute Rule?
In order 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 and this is known as the 8-minute rule. Providers can simply add up the total minutes of skilled, one-to-one therapy and divide that total by 15 to find out the number of billable units for a date of service. According to the rule, if eight or more minutes are remaining, 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 on April 1, 2000, in the United States. 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 8 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?
When it comes to the application of the 8-minute rule, the rule applies only to services where the practitioner has direct contact with the patient. Therefore, the service offered has to be in-person for the rule to apply. Upon receiving more than one service from the provider, Medicare will be billed based on total timed minutes per discipline. However, in case an individual service takes less than eight minutes, Medicare will not be billed for the service.
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)
Here is a quick reference chart of the 8-Minute Rule.
|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 electrical stimulation unattended (ESUN) on a particular date. In order 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.
On top of that, the 15 minutes of ESUN also supports one additional service-based billing unit which makes a total of five units for this date of service.
The Rule of Eights
From the technical point of view, it is a slight variant of CMS’s 8-Minute Rule that can be found in the CPT code manual and is 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. Due to this reason, the math is also applied separately. It is important to note that the rule of eights only applies to timed codes that have 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 in a single visit. As these codes are considered unique services and are counted separately, so the therapist can bill for two units i.e. 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 include:
- 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 beneficiary’s presence
Physician’s documentation is the appropriate place to justify the decision to bill for assessment and management time. If the documentation accurately describes the treatment and another provider can understand it easily, then payers will most likely greenlight the extra minutes.
How to avoid 8-Minute Rule mistakes?
There are some tricky scenarios in the 8-minute rule that can negatively affect your billing. So, in order to ensure accurate billing calculations, providers and billers can leave long division to an EMR with built-in 8-Minute rule functionality.