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The Medicare 8 Minute Rule Explained for Physical Therapy

Making Medicare’s 8 Minute Rule

When billing for rehabilitation services provided to Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) requires therapists adhere to what’s referred to as the “8 Minute Rule”. This term is a little misleading as it seems to imply if you do at least 8 minutes of any procedure defined as a timed code you may bill 1 unit for that. Unfortunately, as is often true with CMS, it’s not that simple.

How to time your services. Not as simple as you might think.

Let’s first start with reviewing timed codes and how you “time” your services. According to the Local Coverage Determination (LCD) from the Medicare Administrative Contractor National Government Services (found here), timed codes are those defined as requiring one-on-one care. This means you are only attending to that patient during the time the service is being provided, and that time is spent providing skilled services. In other words, you cannot be working with another patient or doing documentation or anything else at the same time.
It also means that you must be the one providing the procedure. Any service provided by an aide is considered unskilled, therefore unbillable, and does not meet the one-on-one definition. Further, time spent resting, changing, waiting for equipment, for example, is not skilled care, and thus not billable time. Conversely, time spent determining the patient’s status that day, how they tolerated the previous session, or whether there was a change in their medical status would be considered “skilled”, and therefore billable time.

How to apply the 8 minute rule - figuring out your maximum potential units:

With all the above in mind let’s consider how the 8 minute rule is applied correctly. First, you should total all the time spent on timed procedures and modalities (like ultrasound or attended e-stim). This should exclude any time spent on untimed codes like many modalities or evaluations/re-evaluations. Utilizing the chart below (from www.ngsmedicare.com) you should determine the total number of timed coding units you may bill.
UnitsNumber of Minutes
1 Unit≥ 8 Minutes and ≤ 22 Minutes
2 Units≥ 23 Minutes and ≤ 37 Minutes
3 Units≥ 38 Minutes and ≤ 52 Minutes
4 Units≥ 53 Minutes and ≤ 67 Minutes
5 Units≥ 68 Minutes and ≤ 82 Minutes
6 Units≥ 83 Minutes and ≤ 97 Minutes
7 Units≥ 98 Minutes and ≤ 112 Minutes
8 Units≥ 113 Minutes and ≤ 127 Minutes
If the total time of timed procedures is 28 minutes you may bill 2 units of timed codes (eg: 15+7) or if you’ve done 56 minutes of timed procedures you may bill 4 units of codes, and so on.

Assigning units to codes appropriately

Next you will need to determine which codes to appropriately assign the correct number of units. This has to be done based on the number of minutes each service was provided although there are some caveats. First for any service provided for at least 15 minutes you must bill 1 unit. Sometimes that’s easy: if you provide 15 minutes of Therapeutic Exercise you bill 1 unit of that code, 30 minutes of Neuromuscular Re-education is 2 units of that code.
 
But let’s look at some examples of how you bill when you have total time not evenly allotted to 15 minute increments, which is most typical:

Example 1:

Let’s say you do:

25 minutes of therapeutic exercises + 23 minutes of therapeutic activities = 48 minutes total

Using the chart above you see you will bill 3 units. You must bill 1 unit of therapeutic exercise and 1 unit of therapeutic activities. But you have 10 min of therapeutic exercise left over and 8 minutes of therapeutic activities remaining. You now need to bill the code for which you have the most remainder minutes (therapeutic exercises). So you add the therapeutic activities minutes to the therapeutic exercise minutes and bill one more unit of therapeutic exercises.

Example 2:

Here’s another one:

32 minutes of therapeutic exercises + 7 minutes of manual therapy = 39 minutes

According to the chart you can bill 3 units again based on total time. Your bill would need to have 2 units of therapeutic exercises which equals 30 minutes with 2 minutes remainder. You don’t meet the 8 minute requirement for manual therapy alone because of the 7 minutes but since it is more than the 2 minutes remaining from the therapeutic exercises you add those minutes to the 7 minutes and can now bill for 1 unit of manual therapy.

Example 3:

One more example:

7 minutes of manual therapy + 8 minutes therapeutic activities + 7 minutes of patient education Self-care/Home Management Training = 21 minutes

Because the total time is only within the range for 1 unit that’s all you may bill. The procedure with the most minutes is therapeutic activities to you would bill 1 unit of that code and include the other minutes in that billing.

Does the 8 minute rule apply to all insurances?

The 8-minute rule is generally only applicable to Medicare patients. Other third party payers typically use the midpoint rule where you may bill one unit for any timed procedure or modality that you perform for 8 or more minutes. The total time requirement is not in play here. As always, this does depend on your payer contracts so be sure you know those details as well as any updates in these rules for these payers.

The bottom line

The 8 minute rule is nothing to be afraid of. With a clear understanding of what the rule means you can ensure that you’re not over billing or under billing. You deserve to be paid for the services you provide in accordance with Medicare’s rule. MWTherapy can help you with Medicare compliance giving you built-in tools to help keep you on track.

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