The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable “unit” of service refers to the time interval for the service. Under the 8-minute rule, units of service consist of 15 minutes each.
What is the 8-minute rule for Medicare Part B billing?
Using CMS’s interpretation of aggregating timed procedure codes (the 8-minute rule) is mandatory when you submit reimbursement claims for Medicare Part B billing. However, some private insurers use the 8-minute rule, the AMA Rule of Eights, or their own proprietary billing rules.
Does Medicare require the 8-minute rule for outpatient services?
Since Medicare requires the 8-minute rule to be followed for these in-person, outpatient services, providers do not have the choice of using another billing method. Lynne visits the hospital where her physical therapist’s office is located. She receives 31 minutes of therapeutic exercise and 14 minutes of manual therapy.
How do you calculate the 8 minute rule in medical billing?
Per the 8-Minute Rule, you would first calculate the total treatment time: 30 min + 15 min + 8 min + 30 min = 83 total minutes According to the 8 minute rule chart, you could bill a maximum of 6 units. However, in this case, when adding up your direct time (time-based) codes, it equals 53 minutes.
What is the 8 minute rule in nursing?
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.
How Does Medicare’s 8-Minute Rule Work?
How long does Medicare require for outpatient services?
How many minutes does Medicare take?
What is the 8 minute rule for Medicare?
How long is Medicare billing?
How long does Gregory visit his physical therapist?
Does Medicare require 8 minute billing?
See more
What is the 8-minute Medicare rule?
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.
What is the 8-minute rule and how is the time billed for two units?
Introduced in December 1999, the 8-minute rule became effective on April 1, 2000. The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable “unit” of service refers to the time interval for the service.
How do you find the 8-minute rule?
To calculate the number of billable units for a date of service, providers must add up the total minutes of skilled, one-on-one therapy and divide that total by 15. If eight or more minutes remain, you can bill one more unit. Otherwise, you cannot.
What insurances follow 8-minute rule?
Please note that this rule applies specifically to Medicare Part B services (and insurance companies that have stated they follow Medicare billing guidelines, which includes all federally funded plans, such as Medicare, Medicaid, TriCare and CHAMPUS).
Why is it called the 8-minute rule?
The 8-Minute Rule was established because, according to CPT guideless, each timed code represents 15 minutes of treatment. As you may realize, not every treatment time for these codes will divide into exact 15 minute blocks. As a result, the 8-Minute Rule was born!
How many minutes is 3 units for Medicare?
40 minutesAppropriate billing for 40 minutes is for 3 units. Bill 2 units of 97110 and 1 unit of 97140.
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 often do you need a progress note for Medicare?
once every 10 treatment visitsProgress Reports need to be written by a PT/OT at least once every 10 treatment visits.
Can a therapist bill Medicare Part B for treating more than one patient at the same time?
Therapists, or therapy assistants, working together as a "team" to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient. CPT codes are used for billing the services of one therapist or therapy assistant.
What is the difference between Rule of 8?
Divisibility Rule of 8 If the last three digits of a number are divisible by 8, then the number is completely divisible by 8. Example: Take number 24344. Consider the last two digits i.e. 344. As 344 is divisible by 8, the original number 24344 is also divisible by 8.
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.
Is ultrasound a time based code?
For example, types of time-based CPT codes include: Manual therapy (97140), Ultrasound (97035), Therapeutic exercises (97110), and.
What are Mixed Reminders?
What if, when you divide your direct time minutes by 15, your remainder represents a combination of leftover minutes from more than one service (for example, 5 minutes of manual therapy and 3 minutes of ultrasound)? Do you bill for one service, all of the services, or none of them? 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. (In the example above, you would bill 1 additional unit of manual therapy).
What about Non-Medicare Insurances?
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 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.
What is a time based billing code?
Time-based (or constant attendance) codes allow for variable billing in 15-minute increments. These differ from service-based (or untimed) codes, which providers can only bill once regardless of how long they spend providing a particular treatment.
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 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.
What is the 8 minute rule for Medicare?
All federally funded plans—including Medicare, Medicaid, TriCare, and CHAMPUS—require use of the 8-Minute Rule, as do some commercial payers. To determine the requirements for individual payers, it’s best to contact the payer directly.
What are service-based CPT codes?
You would use a service-based (or untimed) code to bill for services such as:
Does assessment and management time count toward the 8-Minute Rule?
Often, therapists make the mistake of omitting assessment and management time when counting billable minutes. However, according to John Wallace, WebPT’s Chief Business Development Officer of Revenue Cycle Management (RCM), CPT codes actually do make allowances for assessment and management time. That time includes “all the things you have to do to deliver an intervention,” such as:
What is the 8 minute rule?
WebPT automatically double-checks your work for you, alerts you if something doesn’t add up correctly, and lets you know whether you’ve overbilled or underbilled.
What is the 8 minute rule for Medicare?
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. What every physical therapist needs to know about physical therapy billing .
How long do you have to be on Medicare for a treatment?
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.
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.
How many units are in 15 minutes of ESUN?
The 15 minutes of ESUN supports one additional service-based billing unit for a total of 5 units for this date of service.
Service-Based versus Time-Based CPT Codes
CPT stands for Current Procedural Terminology. Service-based CPT codes are used for things like physical therapy exams, unattended electrical stimulation, or applying hot/cold packs. Service-based CPT codes are billed as one unit, no matter how much time was spent delivering the treatment.
Providers Who Use Time-Based CPT Codes
There are several types of providers that employ Medicare’s 8-minute rule. This includes those at private practices, skilled nursing facilities, home health agencies, rehabilitation facilities, and hospital outpatient services.
Calculating Billable Units and the Medicare 8-Minute Rule
Providers such as physical therapists who use CPT coding must follow a set of rules. One of those rules is Medicare’s 8-minute rule.
Other Programs That Utilize the 8-Minute Rule
Medicare is not the only program that uses the 8-minute rule for time-based CPT codes. Medicare, TRICARE, and CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) all use the 8-minute rule. While not the majority, some commercial insurance plans also utilize the rule.
What is the 8 minute rule?
That means Medicare will reimburse a treatment based on how many of these 15-minute increments or billable units it entailed.
How long is a 15 minute block?
Within a 15-minute block of time, you cross the half-way point at 8 minutes…well, technically, 7 minutes and 30 seconds. Think of 8 minutes as the tipping point. Once you’ve crossed 8 minutes, the 15 minute block counts as a unit! By spending at least 8 minutes with your patient, you’ll “satisfy” the majority of the 15-minute block ...
Why do 7 minutes count as timed minutes?
Those 7 minutes spent on therapeutic activity still count toward timed minutes because Therapeutic Activity is a timed code. Therefore, the therapist can ethically bill 2 units of neuromuscular re-ed because neuro re-ed was a larger focus of the treatment in terms of minutes spent.
How long is a treatment for a billable unit?
Sometimes a treatment doesn’t fit nice and neatly into 15-minute intervals. Because of that, CMS will allow just 8 minutes to count as one billable unit.
How long is a 15 minute treatment?
CMS qualifies the 15-minute rule as any treatment “ greater than or equal to 8 minutes through and including 22 minutes.”. So if your treatment was 20 minutes, you only have one unit to bill. This works incrementally as you accumulate units:
Is 8 minutes a timed CPT?
Remember: the 8-minute rule only counts for “timed” minutes, regardless of the total treatment time (which may include “untimed” minutes such as hot/cold packs). So which CPT codes are “timed” and which are “untimed”?
Is there a 15 minute rule for a therapist?
It’s technical ly a “15-minute rule” according to CMS, but we therapists refer to it as the 8-minute rule because that’s when reimbursement kicks in.
How Does Medicare’s 8-Minute 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 8-minute rule to apply.
How long does Medicare require for outpatient services?
Since Medicare requires the 8-minute rule to be followed for these in-person, outpatient services, providers do not have the choice of using another billing method.
How many minutes does Medicare take?
The services are then billed in 15-minute units. Therefore, if a service or services take (s) 20 minutes, Medicare will be billed for one unit, because the number of minutes falls between eight and 22. If 23 to 37 minutes is spent on the service (s), Medicare can be billed for two units. If the service (s) take (s) 38 to 52 minutes, ...
What is the 8 minute rule for Medicare?
What is the Medicare 8-Minute Rule? Medicare’s 8-minute rule is a stipulation that applies to time-based CPT codes for outpatient services, such as physical therapy. Introduced in December 1999, the 8-minute rule became effective on April 1, 2000.
How long is Medicare billing?
The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable “unit” of service refers to the time interval for the service. Under the 8-minute rule, units of service consist of 15 minutes each.
How long does Gregory visit his physical therapist?
This visit totals 46 minutes, so the office will charge Medicare for three units of service.
Does Medicare require 8 minute billing?
Since Medicare requires the 8-minute rule to be followed for these in-person, outpatient services, providers do not have the choice of using another billing method.
The Basics
Time-Based vs. Service-Based
Minutes and Billing Units
What Are Mixed Reminders?
What About Non-Medicare Insurances?
to Bill Or Not to Bill?
The 8-Minute Rule in WebPT
8-Minute Rule FAQ
- What is the 8-Minute Rule?
Put simply, 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. To calculate the number of billable units for a date of service, providers must add up the total minutes of skilled, one-on-o… - What are time-based CPT codes?
Time-based (or constant attendance) codes allow for variable billing in 15-minute increments. These differ from service-based (or untimed) codes, which providers can only bill once regardless of how long they spend providing a particular treatment.
Introduction
What Are Service-Based Cpt Codes?
What Are Time-Based Cpt Codes?
What’s The Deal with Mixed Remainders?
So What Is The Rule of Eights?
Does Assessment and Management Time Count Toward The 8-Minute Rule?
What’s The Best Way to Avoid 8-Minute Rule Mistakes?