What is the 8 minute rule?

Asked by: Jacky Emmerich  |  Last update: February 11, 2022
Score: 4.3/5 (12 votes)

Medicare's 8-minute rule is a stipulation that applies to time-based CPT codes for outpatient services, such as physical therapy. ... The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes.

How does the 8 minute rule work?

Enter the 8-Minute Rule

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 8 minute rule in therapy?

A therapist must provide direct one-to-one therapy for at least 8 minutes to receive reimbursement for a time based treatment code. When only one service is provided in a day, you shouldn't bill for services performed for less than 8 minutes.

What is the 8 minute rule and how is the time billed for two units?

Two 8 minute rule billing scenarios

(2 units (15 minutes each) for therapeutic exercise and 2 units (15 minutes each) for therapeutic activity). Leaving 5 minutes and 3 minutes left over which adds up to 8 minutes.

What is the AMA 8 minute rule?

That's where the 8-Minute Rule comes in; if a therapist provides direct, one-on-one therapy for at least eight minutes, they will be paid for one unit of a time-based treatment code.

Caedrel explains the 8 minute Rule

27 related questions found

Who follows the 8-minute rule?

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. If you've received more than one service, Medicare will be billed based on total timed minutes per discipline.

Does United Healthcare Follow 8-minute rule?

These services are referred to as “timed codes” within the policy. Note: In alignment with the Centers for Medicare and Medicaid Services (CMS), at least eight minutes of therapy services must be performed to meet the minimum time qualification to bill one 15 minute unit.

Does Tricare follow the 8-minute rule?

A: Yes, TRICARE has stated they follow Medicare's “8-minute rule.” This is based on phone calls with TRICARE.

Does Medicare Advantage follow 8-minute rule?

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

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

The 8-minute rule, or rule of eights, is there to help therapists determine how many units they can bill to Medicare for the outpatient services they administer on a particular service. ... The rule does not apply to Medicare Part A services.

Is 97014 a timed code?

CPT 97014/G0283 is appropriate for pad-based e-stim, which requires supervision only. Although this is not a time-based service, accepted protocols require 15 minutes to as much as 30 minutes of treatment. ... This is a time-based service reported in 15-minute units.

Is 97035 a timed code?

The following codes are timed codes: 97032 - Electrical Stimulation (Manual) 97033 - Iontophoresis. 97035 - Ultrasound.

What is the 3 minute rule?

Ditch the colorful slides and catchy language. And follow one simple rule: Convey only what needs to be said, clearly and concisely, in three minutes or less. That's the 3-Minute Rule.

Is 97116 a timed code?

For example, a patient under a PT plan of care receives skilled treatment consisting of 20 minutes of therapeutic exercise (CPT 97110) and 20 minutes of gait training (CPT 97116). The total “Timed Code Treatment Minutes” documented will be 40 minutes.

How many therapy units is 45 minutes?

Timed Minutes: 45

However, billing is based ultimately on total timed minutes – 45 in this case, and equivalent to 3 billable units. Those 7 minutes spent on therapeutic activity still count toward timed minutes because Therapeutic Activity is a timed code.

How does a 7 minute time clock work?

The 7-minute rule, also known as the ⅞ rule, allows an employer to round employee time for payroll purposes. Under FLSA rules, employers can round employee time in 15-minute increments (or to the nearest quarter hour). Any time between 1-7 minutes may be rounded down, and any minutes between 8-14 may be rounded up.

How does PT billing work?

A bill is submitted to the patient, third-party payer directly, or a 'claims clearinghouse' that prepares the bill. The claims clearinghouse will submit the bill to the payer. The clinic can also do this but if you're using a billing service, that's one less step you have to do 'in house. '

What is a unit of therapy?

It is important to understand what unit of treatment means. The “unit of treatment” means, who should be in the office at one time. ... There are many possibilities to this question and it largely depends on what the problems are that are being addressed.

Is ultrasound a timed code?

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

How do you bill based on time?

This can be done in various ways. One way is to simply say, “Visit time 30 minutes, counseling time 20 minutes.” Some physicians alternately use a statement that says, “This was a 30-minute visit, with greater than 50 percent counseling.”

How do you bill by time?

A sample billable hours chart

The chart uses increments of 1/10th of an hour. For example, if you worked for 15 minutes at a rate of $100 per hour, you could use the chart to see that the time increment is 0.3. So, 0.3 x $100 = $30 to bill.

Who can Bill 97129?

Psychologists must now use the stand-alone base code, 97129, to report the first 15 minutes of performing the primary service, and a 15-minute add-on code, 97130, which can be reported in multiple units, to report additional time (beyond the initial 30 minutes) required to complete the overall service.

Does Medicare cover CPT 97116?

Gait Training (CPT Code: 97116)

Medicare will cover Gait Therapy for training patients whose walking abilities have been impaired by neurological, muscular or skeletal abnormalities or trauma.

Can a chiropractor use GP modifier?

Medicare also requires the GP modifier for physical medicine codes; however, since Medicare does not cover physical medicine services when rendered by Doctors of Chiropractic, your billed physical medicine services would include both the GP and GY (non-covered service) modifiers.