The 8-Minute Medicare Rule is put in place to govern the process by which rehab therapists determine how many units they should bill to Medicare. This is for the outpatient therapy services they provide on the specific service dates. A therapist has to offer direct one-on-one time therapy for at a minimum of 8-minutes to receive reimbursement for one unit of a time-based treatment code.
Time-based codes allow for variable billing in 15-minute increments. Time codes would be used for performing one-on-one services such as ultrasound, manual therapy, therapeutic activities, electrical stimulation, neuromuscular re-education, therapeutic exercise, and gait training.
What is the 8-minute Medicare Rule?
The 8-Minute Medicare Rule is for time-based codes. There must be a direct treatment for at least eight minutes before receiving reimbursement from Medicare.
When calculating the number of billable units for a particular service date, Medicare will add up the total minutes of one-on-one therapy and divide that by 15. If eight or more minutes are left over after a session, this can allow for one more unit to be billed, whereas if there are only seven or fewer minutes left, then an additional unit cannot be billed.
A chart can be used to reference how many units can be charged for some time. For example, it will start at eight to twenty-two minutes, resulting in 1 unit. The full-time reference is 83 minutes which will rack up to 6 units.
Example of the 8-minute Rule:
As an example of how the 8-minute rule will apply in a single date of service. Let’s say that there were 30 minutes of manual therapy, 15 minutes of therapeutic exercise, 15 minutes of electrical stimulation unattended, and 8 minutes of ultrasound. The constant attendance procedures and modalities will be added to correctly calculate the charge using the 8-minute rule.
Resulting in a sum that will look like this:
30+15+15+8= 53 minutes which supports the amount of four billing units.
The 15 minutes of electrical stimulation unattended will support one added service-based unit. That will be a total of 5 units for the date of service used above.
Often when the total timed minutes are divided by 15, there will be a reminder that will include minutes from more than one service. For example, when these minutes are combined, you have 5 minutes leftover from therapeutic exercise and then 3 minutes leftover from manual therapy. Separately these do not meet the 8-minute requirement but once added, they then fit into the 8-minute threshold. However, as per Medicare guidelines, this means that you can bill one unit of the service with the larger amount of time total, so regarding the situation we discussed, the therapeutic exercise will be the one that can be billed for.
What does the Rule of 8 Stand for?
The 8-minute rule stipulates that you can bill Medicare Insurance carriers for one full unit if the service provided is between 8 and 22 minutes. It can only apply to time-based CPT codes. Keep in mind that the 8-Minute Medicare Rule does not apply to every time-based CPT code or in every situation that might occur.
The billing for physical medical services is based on what is referred to as the Current Procedural Terminology (CPT) coding system. This system is composed of 5 digit codes used for third-party billing payers.
Often Medicare is the primary third-party payer that will foot the bill for outpatient physical medicine services. These payments will typically be based on a fee schedule based on the time codes and the 8-Minute Medicare Rule.
The first procedure has to be at the least 8 minutes, and then each one after that will be billed in 15-minute increments. Only direct one-on-one and face-to-face time with a patient will be considered for timed codes.
The rule of eights still counts billable units in 15-minute increments; however, instead of combining the time from multiple units, the rule is applied apart from the unique timed services.
Is Assessment and Management Part of the 8-Minute Rule?
On some occasions, therapists will mistake adding assessment and management time when counting the billable minutes. Not in every case, the assessment and management time can be omitted. There are some instances where there are allowances. Some examples of this are:
- Documenting in the presence of a patient.
- Assessing the patient prior to performing a hands-on intervention.
- Answering patients and if there is a caregiver present, then their questions as well.
- Assessing the patient’s response to the intervention.
- Instructing, counseling, and giving advice about home self-care.
If your documentation is accurate, describes the treatment, is easily understood by another provider. This will be enough to justify the reason behind billing for assessment and management. If the time that wasn’t used by performing the medical practice is still in the scope and will aid in the condition or problem that the patient is facing, then it is allowed and justified for the therapist to bill for this information or insight.
One Last Minute of Your Time
The 8-Minute Medicare Rule is put in place to keep order and understanding when billing patients. It ensures the correct amount is being charged and helps the patient understand how the Medicare time is billed. The charges made based on the added time and then divided by 15 will be sent to Medicare. If time is left over from any medical situation, they can be added together. If they reach a total of 8 minutes, then whichever has the most extra time will be given one unit.