The key feature of the 8-Minute Rule—and the origin of its namesake—is that 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 correctly apply the 8-Minute Rule, you must first understand the difference between service-based CPT codes and time-based ones.
What are Service-Based CPT Codes?
You would use a service-based (or untimed) code to bill for services such as:
- conducting a physical therapy evaluation (97001) or re-evaluation (97002)
- applying hot/cold packs (97010)
- performing electrical stimulation (unattended) (97014)
In such scenarios, you can only bill for one code regardless of how long you spend providing treatment.
What are Time-Based CPT Codes?
Time-based (or constant attendance) codes, on the other hand, allow for variable billing in 15-minute increments. You would use these codes for one-on-one services such as:
- therapeutic exercise (97110)
- therapeutics activities (97530)
- manual therapy (97140)
- neuromuscular re-education (97112)
- gait training (97116)
- ultrasound (97035)
- iontophoresis (97033)
- electrical stimulation (97032)
Enter the 8-Minute Rule.
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.
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8-Minute Rule Reference Chart
Below is a quick reference chart. In this chart, the numeric range in the left column represents the total timed minutes, and the sum on the right represents the maximum number of units you can bill according to that time total.
|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|
After using the 8-Minute Rule to determine the appropriate number of time-based units for a particular visit, add that total to your number of service-based units. The resulting sum is the total number of units you can bill Medicare for a particular date of service.
8-Minute Rule Example
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 and modalities:
30 min + 15 min + 8 min = 53 direct timed minutes, which supports 4 billing units.
The 15 minutes of ESUN supports an additional service-based billing unit for a total of 5 units for this date of service.
What’s the Deal with Mixed Remainders?
Many times, when you divide the total timed minutes by 15, you get a remainder that includes minutes from more than one service. For example, you might have 5 leftover minutes of therapeutic exercise and 3 leftover minutes of manual therapy. Individually, neither of these remainders meets the 8-minute threshold. When combined, though, they amount to 8 minutes—and per Medicare billing guidelines, that means you can bill one unit of the service with the greatest time total (which, in this case, would be therapeutic exercise).
What about the AMA 8-Minute Rule?
The main difference between Medicare’s 8-Minute Rule and the AMA’s version is how each one handles mixed remainders. Under AMA guidelines, you cannot bill additional units based on the cumulative total of your remainders. In other words, if your leftover minutes result from a combination of services, you cannot bill for any of those remainders unless one of them totals at least eight minutes. So, in the example above, you could not bill for any additional units, because neither the 3 minutes of manual therapy nor the 5 minutes of therapeutic exercise meets the 8-minute minimum.
What's the Best Way to Avoid 8-Minute Rule Mistakes?
The 8-Minute Rule has enough tricky scenarios to trip up even the whizziest math whiz. So, if you want to ensure accurate billing calculations, leave the long division to an EMR with built-in 8-Minute Rule functionality. 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.