what is the 8 minute rule for medicare

by Dr. Sebastian Harber Published 2 years ago Updated 1 year ago

The 8 Minute Rule - How Does It Work?

Untimed Codes. Untimed Codes are billed one unit per date of service regardless of the number of anatomical body areas treated.
Timed Codes. Timed codes are billed using Medicare's 8 Minute Rule.
8 Minute Rule Table. ...
Computing Billable Units. ...

The 8-minute rule states that to receive Medicare reimbursement, you must provide treatment for at least eight minutes. Using the “rule of eights,” billing units that are normally based on 15-minute increments spent with a patient can be standardized.Nov 1, 2019

Full Answer

Does Medicaid follow a 8 minute rule?

What is the 8-Minute Rule? The 8-minute rule is used by pediatric therapists, including occupational therapists, physical therapists, and speech therapists, to determine how many units they should bill to Medicaid for any outpatient services they provide. Each timed code is supposed to represent 15 minutes of treatment.

What is the 8 minute rule for Medicare?

What is the 8 minute rule? The 8 minute rule is a Medicare guideline for determining how many billable units may be charged in rehabilitation based on time spent with the patient. Billable units are based on 15 minute increments, once the initial 8 minutes have been met, which is how the name “8 minute rule” developed.

What are the requirements for Medicare billing?

The regular physician is unavailable to provide the service.
The beneficiary has arranged or seeks to receive the services from the regular physician.
The locum tenens is NOT an employee of the regular physician.
The regular physician pays the locum tenens physician on a per diem or fee-for-service basis.

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How your DRG is determined for billing?

individual hospital’s base payment rate by the weight of the DRG. The weight of a DRG is determined by the intensity of resources, on average, that are needed to treat that kind of case. When a patient is discharged, the physician summarizes information on a discharge face sheet. This information includes principal diagnosis, additional diagnoses, and procedures performed during the stay.

Does the 8-minute rule apply to Medicare Part A?

The rule does not apply to Medicare Part A services.

What insurances follow 8-minute rule?

Non-Medicare Insurances That means that if your leftover minutes come from a combination of services, you cannot bill for any of them unless one individual service totals at least eight minutes.

How many minutes is 3 units Medicare?

40 minutesAppropriate billing for 40 minutes is for 3 units. Bill 2 units of 97110 and 1 unit of 97140.

Do Medicare Advantage plans follow 8-minute rule?

Medicare requires providers to adhere to the 8-Minute Rule; MA plans may not.

How does the 8-minute rule work?

The 8-minute rule is a stipulation that allows you to bill Medicare insurance carries for one full unit if the service provided is between 8 and 22 minutes. As such, this can only apply to time-based CPT codes. But, the 8-minute rule doesn't apply to every time-based CPT code, or every situation.

How many minutes is a therapy unit?

Unlike service-based CPT codes, time-based CPT codes can be billed as multiple units in 15-minute increments. Meaning that one unit would represent 15 minutes of therapy. A therapist must provide direct one-to-one therapy for at least 8 minutes to receive reimbursement for a time based treatment code.

Does CMS follow the 8-minute rule?

Per CMS, in order to bill one unit of a timed CPT code, you must perform that associated modality for at least 8 minutes. Medicare takes the total time spent in a treatment session and divides by 15 to figure out how many units are rendered on a given service date.

How many minutes is 9 units?

2) 128 minutes and over is billed at a rate of 14 minutes per unit. For example, 128 -142 minutes = 9 units; 143 – 157 minutes = 10 units, etc.

How are therapy minutes calculated?

The 8-minute rule is the method of calculating the number of billable units Physical Therapists (PTs) should bill Medicare or Medicaid. The 8-minute rule applies to direct contact therapeutic services in which physical therapy provides one on one services to a patient for at least eight minutes.

How many units is 55 minutes?

8-Minute Rule Reference Chart8 – 22 minutes1 unit23 – 37 minutes2 units38 – 52 minutes3 units53 – 67 minutes4 units68 – 82 minutes5 units1 more row•Jan 11, 2019

Is ultrasound a time-based code?

For example, types of time-based CPT codes include: Manual therapy (97140), Ultrasound (97035), Therapeutic exercises (97110), and.

How do you maximize physical therapy billing?

Ten Ways Physical Therapists Can Maximize BillingSet goals. As a therapist, you've got a lot of experience in the goal-setting department. ... Track your progress. ... Increase efficiency. ... Educate yourself and your staff. ... Clean up your claims. ... Digitize. ... Know your payer mix. ... Keep an eye on cash flow.More items...•

Medicare 8-Minute Rule Explained

The 8-Minute Rule has been in effect since April 1, 2000, and it applies to time-based current procedural codes for outpatient services.

Getting Supplemental Medicare To Cover for You

The 8-Minute Rule can be a bit confusing and strange for beneficiaries who aren’t used to dealing with it. But it benefits Medicare recipients to understand how their coverage is billed for direct contact services like physical therapy.

How many minutes of therapy should a rehab therapist be on Medicare?

The 8-Minute Rule governs the process by which rehab therapists determine how many units they should bill to Medicare for the outpatient therapy services they provide on a particular date of service (extra emphasis on the word “Medicare” as this rule does not apply to other insurances unless they have specified that they follow Medicare billing guidelines). Basically, a therapist must provide direct, one-on-one therapy for at least eight minutes to receive reimbursement for a time-based treatment code. It might sound simple enough, but things get a little hairy when you bill both time-based and service-based codes for a single patient visit—and therein lies the key to correctly applying this rule.

How long is a CPT code?

According to CPT guidelines, each timed code represents 15 minutes of treatment. But your treatment time for these codes won’t always divide into perfect 15-minute blocks. What if you only provide ultrasound for 11 minutes? Or manual therapy for 6 minutes? That’s where the 8-Minute Rule comes in: Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes. In other words, Medicare adds up the total minutes of skilled, one-on-one therapy (direct time) and divides the resulting sum by 15. If eight or more minutes are left over, you can bill for an additional unit. But if seven or fewer minutes remain, Medicare will not reimburse you for another full unit, and you must essentially drop the remainder. To give a simple example, if you performed manual therapy for 15 minutes and ultrasound for 8 minutes, you could bill two direct time units.

How long should I bill Medicare?

The answer depends on the billing guidelines you’re using. Per Medicare, as long as the sum of your remainders is at least eight minutes , you should bill for the individual service with the biggest time total, even if that total is less than eight minutes on its own.

How long is 15+8+10?

To start, let’s add up the total treatment time: 15+8+8+10 = 41 minutes. According to the chart above, the maximum total codes you can bill for 41 minutes is 3. Now, let’s take the total minutes of constant attendance services: 15+8+8 = 31. Then, divide that number by 15. You get two 15-minute services plus one extra minute.

How many minutes are required for a federally funded program?

Federally funded programs use the 8-Minute Rule. For others, your best bet is to ask. If the insurance company doesn’t have a preference, you may want to calculate your units using both methods to determine which will better serve your practice.

How long does an insurance provider have to charge for a unit of service?

However, it’s important to understand that there are insurers who don’t require providers to adhere to the 8-Minute Rule. As this resource points out, under the Substantial Portion Methodology (SPM), there is no cumulation of minutes or remainders; in order to charge for a unit of service, you must have performed that service for a “substantial portion” of 15 minutes (i.e., at least 8 minutes). That means that if your leftover minutes come from a combination of services, you cannot bill for any of them unless one individual service totals at least eight minutes.

How many units can you bill for time based codes?

If you divide 53 by 15, you get 3 with a remainder of 8, which means you can bill 4 units of time-based codes.

How many minutes of treatment do you need to be on Medicare?

For time-based codes, you must provide direct treatment for at least eight minutes in order to receive reimbursement from Medicare. Basically, when calculating the number of billable units for a particular date of service, Medicare adds up the total minutes of skilled, one-on-one therapy and divides that total by 15. If eight or more minutes are left over, you can bill for one more unit; if seven or fewer minutes remain, you cannot bill an additional unit.

What is the rule of 8?

The Rule of Eights—which can be found in the CPT code manual and is sometimes referred to as the AMA 8-Minute Rule—is a slight variant of CMS’s 8-Minute Rule . The Rule of Eights 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. Therefore, the math is also applied separately. (Keep in mind 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.)

How long do you have to be on Medicare for a treatment?

What is the 8 minute rule for rehab?

Rehab therapists use the 8-Minute Rule—or the slightly variant “Rule of Eights”—to determine the number of units they should bill Medicare for the therapy services provided on a particular date of service. Prev.

How many minutes of 97110 are in a single visit?

For example, say a therapist bills 10 minutes of 97110 and 10 minutes of 98116 in a single visit. Those codes are considered unique services, and are counted separately. Each service lasted longer than eight minutes, so the therapist can bill for two units total: one unit of 97110 and one unit of 98116.

What are the codes for a therapist?

Time-based (or constant attendance) codes, on the other hand, allow for variable billing in 15-minute increments. You would use these codes for performing one-on-one services such as: 1 therapeutic exercise (97110) 2 therapeutic activities (97530) 3 manual therapy (97140) 4 neuromuscular re-education (97112) 5 gait training (97116) 6 ultrasound (97035) 7 iontophoresis (97033) 8 electrical stimulation (manual) (97032)

How long is a manual therapy session?

Let’s say that on a single date of service, you perform 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). To correctly calculate the charge in accordance with the 8-Minute Rule, you would add the constant attendance procedures ...

The Basics

The 8-Minute Rule applies to services where the beneficiary and the healthcare provider have direct contact. This means it must be an in-person visit. Medicare will be billed based on the total number of minutes timed per regulation but won’t be billed if the individual service is less than 8 minutes. Services are billed in 15-minute increments. If...