At first glance, the 8-minute rule may seem fairly straight forward, but there are nuances in this rule that make it more complicated than it appears, especially when billing both time-based and service-based codes on a single patient visit. Let’s look at the rule and what therapists need to be aware of.
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. 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). The rule does not apply to Medicare Part A services.
First, let’s examine the difference between time-based and service-based CPT codes. Service-based, also referred to as untimed, codes are used when performing a physical therapy examination or re-examination, applying hot or cold packs or giving unattended electrical stimulation. These services allow for only one unit to be billed, no matter how long the treatment takes.
In contrast, time-based, also referred to as direct time, codes can be billed in multiple units of 15-minute increments. In other words:
One unit equals 15 minutes of direct therapy
These are for time-based codes where you are providing one-on-one, constant attendance procedures and modalities, like therapeutic exercise or activities, manual therapy, neuromuscular re-education, gait training, ultrasound, iontophoresis or attended electrical stimulation.
In a perfect world, blocks of time for treatment would be divided into 15 minutes of time, but that doesn’t happen. Treatments come in all time ranges and the 8-minute rule dictates how many units can be billed. Medicare states that the associated service must be performed for at least 8 minutes to qualify for a billable unit. Medicare will not reimburse you for seven or fewer minutes. The total number of skilled, one-on-one time is added up and divided by 15. If there are eight minutes or more, Medicare allows for an additional unit. Seven minutes or less, you will not be reimbursed.
Below, you can find a handy chart to help you see how many units you can bill:
|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|
|83-97 minutes||6 units|
As with many complicated rules, there are exceptions to the 8-minute rule. For instance, if you provide skilled treatment for under eight minutes, and the rest of the service is unskilled, you probably won’t be able to bill any direct time for that particular treatment.
Like stated previously, Medicare rules do not apply to other insurance policies unless they specifically say so, so the 8-minute rule may not apply. Private insurance companies usually don’t allow for mixed remainders. Under the Substantial Portion Methodology (SPM), you cannot bill for any leftover minutes that come from a combination of services, unless one of the individual services total eight minutes. Before the 8-minute rule, SPM was how services were billed to all patients, including Medicare beneficiaries. SPM is stilled used with Blue Cross Blue Shield, Aetna, Cigna, auto insurances (Geico, State Farm, AllState) and Workman’s Comp.
In some cases, SPM may actually allow you to bill for more units than the 8-minute rule does, especially when providing more than one service. If in doubt, it’s best to inquire first before billing.
Need further clarification on the 8-minute rule or have billing questions? StrataPT is happy to help. Please contact our friendly team if you want to simplify your billing operations.