Making Medicare’s 8 Minute Rule
How to time your services. Not as simple as you might think.
How to apply the 8 minute rule - figuring out your maximum potential units
|Units||Number 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|
Assigning units to codes appropriately
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.
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.
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.