Are you among the people who often wonder about the meaning of Medicare 8-minute rule physical therapy? Do not worry, this blog is written for you and will answer all the questions on your mind.
Medicare is known for its strict regulations on the medical billing and reimbursement process. This means healthcare professionals must abide by its rules to ensure proper compliance and one of these regulations is the Medicare 8-minute rule.
Healthcare providers of the same practice often spend a lot of time diagnosing their patients. While some spend little to no time, others take their time to ask their patient multiple questions before reaching the conclusion on their diagnosis. Medicare viewed this to be unfair, especially for healthcare providers who put in the work with their whole heart and time. This process made them introduce the 8-minute rule for healthcare providers.
Continue reading as Unify Medicraft takes you through the meaning of the Medicare 8-minute rule, how it works, and some examples. By the end of this blog, you will be able to understand the complexities of the Medicare 8-minute rule and accurately bill for your services.
What is the Medicare 8-Minute Rule in Physical Therapy?
The Medicare 8-minute rule physical therapy dictates that healthcare providers must spend at least eight minutes with their patient face-to-face before they can file for one unit of the treatment code. Anything less than that is not recognized or approved by Medicare as a billable unit.
When it comes to physical therapy billing guidelines for Medicare, the instructions are quite specific. That's why proper documentation is crucial to receive payment from Medicare for direct treatment and any mistake can lead to missed revenue.
How Does Medicare 8-Minute Rule Work?
We know calculating the Medicare 8-minute rule when billing can sometimes be confusing. But Unify Medicraft is here to explain every detail to you and help you navigate the billing process.
To calculate the number of billable units, the therapist only needs to add the total minutes spent one-on-one with their patient and divide it by 15. The therapist can bill for one more unit if the calculation remains eight or more. Any number lower than that cannot be billed as an additional unit.
Here is a simple and effective way to use the Medicare 8-minute rule while billing.
Long Division
Start by dividing the total time (in minutes) spent with the patient by 15. If the number that remains is more than 8, one unit can be added to the whole number.
For example, if a therapist spends 27 minutes with the patient, the number will be divided by 15 which is equal to 1 and remains 8. This means the therapist can add another unit making it 2 billable units.
Start with Eight
This method works by using 8 as your base for one unit and adding multiples of 15 for every unit. For example, you calculate two units by adding 8 + 15, or 23. Three units by adding 8 + 30 until the last unit.
What Codes Apply to the 8-Minute Rule?
The Current Procedural Terminology codes for Medicare 8-minute rule in physical therapy includes time-based and service-based codes. Physical therapists can only bill service-based codes once in a session with a patient no matter how long the service takes to complete.
Examples of service-based CPT codes :
- PT evaluation (97161, 97162, 97163)
- PT re-evaluation (97164)
- Electrical stimulation (unattended) (97014)
- Hot/cold packs (97010)
- Group therapy (97150)
Time-based codes on the other hand are used to bill for services that require one-on-one skilled therapy session with the physical therapist. While providing this service, the therapist cannot attend to another patient because they are actively engaging with the patient.
Examples of time-based and rehabilitative therapy CPT codes :
- Electrical stimulation (manual) (97032)
- Ultrasound (97035)
- Gait training (97116)
- Therapeutic exercise (97110)
- Manual therapy (97140)
- Neuromuscular re-education (97112)
- Self-care/home management training (97535)
- Prosthetic training (97761)
- Physical performance test or measurement (97750)
How to Calculate Billable Units and 8-Minute Rule Chart?
When calculating how many units you can bill for a timed service, the Centers for Medicare & Medicaid Services requires you to use the 8-minute rule chart. This means you must spend a minimum of 8 minutes with your patient for a billable unit.
Let's break down how to calculate your billable unit for more clarity.
Step 1
After attending to a patient, you will add all the time spent together to know the total units you can bill.
Step 2
Separate each whole 15-minute unit by CPT code. For example: Two units of CPT code 97761 equal 30 minutes of service.
Step 3
If you have minutes remaining that cannot be converted into units, the Centers for Medicare & Medicaid Services allows billers to round it up to a whole unit by using other services.
For example: If you have 5 minutes remaining from 97110 and 10 minutes remaining from 97140, you can add them together to get 1 unit of 97140.
Step 4
A therapist can bill for another unit if there are still 8 or more minutes remaining from their service since one unit is between 8 to 22 minutes according to the Centers for Medicare & Medicaid Services.
What are Service-Based CPT Codes?
A service-based current procedural terminology code is defined as a one-time therapy service provided to the patient regardless of the time spent while attending to the patient. The service-based code is used in billing for the following services.
- Physical therapy evaluation (97161, 97162, or 97163)
- Physical therapy e-evaluation (97164)
- Hot/cold packs (97010)
- Electrical stimulation (unattended) (97014 or G0283 for Medicare)
What are Time-Based CPT Codes?
A time-based current procedural terminology code is defined as a code based on the time spent by a therapist while attending to the patient. This code is guided by the 8-minute rule and the therapist must adhere to it to ensure reimbursement.
The time-based code is used in billing for the following services :
- Therapeutic exercise (97110)
- Therapeutic activities (97530)
- Manual therapy (97140)
- Neuromuscular re-education (97112)
- Gait training (97116)
- Ultrasound (97035)
- Iontophoresis (97033)
- Electrical stimulation (manual) (97032)
Medicare 8-Minute Rule in Physical Therapy Examples
The Medicare 8-minute rule in physical therapy is followed to avoid billing issues. Here are examples of how the 8-minute rule can be used to bill Medicare for rehab therapy services:
Physical Therapy
A physical therapist helps a patient through therapeutic exercises to address a musculoskeletal condition for 33 minutes. After the session, the 33 minutes will be divided by 15 which equals 2 and remains 3.
The therapist can only bill for 2 units for this session because the remaining number is 3 which is less than 8, the billable unit.
Occupational Therapy
A physical therapist helps a patient through their prosthetic training session for 30 minutes. Let's apply the 8-minute rule- the 30 minutes is divided by 15 which equals 2. The therapist can bill Medicare for 2 units.
Speech-Language Pathology
A speech therapist offers a speech-language pathology session with a patient dealing with communication difficulties for 72 minutes. After the session, the 72 minutes is divided by 15, which gives 4 and remains 8. Following the 8-minute rule, the therapist can add another unit to 4, making a total of 5 billable units.
What are Mixed Remainders?
The phrase mixed remainders are used in Medicare billing when your remaining minutes consist of more than one billing code.
For example, when a physical therapist has 5 minutes left from a therapeutic exercise session and 3 minutes left from a manual therapy session. The remaining minutes in each session can be combined together to achieve the 8-minute rule. According to Medicare billing guidelines, the therapist will bill 1 unit for the session with the highest minutes.
What is the Rule of Eights?
The Rule of Eights is a billing guideline used by the American Medical Association to decide how therapists bill for the time they spend with patients during therapy sessions. Although the rule counts billable units in 15-minute increments, it does not allow mixed remainders.
Difference Between 8 Minute Rule and The Rule of Eights
The 8-minute rule and the Rule of Eights are different rules that cannot be used interchangeably. Though similar in name and follow the same basic principle, their applications are very different. Let us take a look at their differences.
Different Payers
The 8-minute rule is used by many insurance companies across the United States. However, each of them has a different billing process. For example, the Medicare 8-minute rule allows therapists to combine remainders from multiple sessions while the Rule of Eights introduced by the American Medical Association does not allow it.
Calculating billable units
The Medicare 8-minute rule combines all time-based services for one patient and then calculates the number of billable units while the Rule of Eights determines the billable units for each time-based service separately.
Mistakes to Avoid 8-Minute Rule in Physical Therapy
Mistakes are inevitable they say, but these words do not apply to the physical therapy medical billing process. Using accurate billing services and integrating advanced tools such as EMR in your practice will avoid any error in your 8-minute rule . It also decreases the chances of overbilling or undercharging while increasing patient care and revenue.
Conclusion of Medicare’s 8-Minute Rule
The 8-minute rule is an important part of the physical therapy billing and documentation process. It affects how both physical therapists in direct contact services and those remotely monitoring their patients calculate their billable units. The 8-minute rule also applies to healthcare providers offering individual, group, and electrical stimulation services.
Physical therapists in clinics, hospital outpatient and inpatient acute settings must understand the 8-minute rule to ensure accurate billing and compliance with Medicare’s guidelines.
Medical billing is very hectic, time-consuming and does not let the physical therapist focus on their actual work. Therefore, they need software like Unify Medicraft that design for their specialty. Our all-in-one software is what your practice needs to avoid claim denial and revenue growth.
FAQs about the Medicare 8 Minute Rule in Physical Therapy
Is The 8-minute Rule Mandatory?
Yes, physical therapists must follow the 8-minute rule when billing for Medicare.
What are the Common Mistakes in Calculating Billable Units?
- Incorrect procedure codes
- Not accurately reporting time spent with patients
- Rounding up the remainders when calculating unit according to the 8-minute rule
- Adding time spend in patient documentation with session time
Does the 8 Minute Rule Apply to Group Therapy Codes?
No, the 8-minute rule does not apply to group therapy and service-based CPT codes.
Which Billing Method is Better Between the 8 Minute Rule or SPM?
Both 8 Minute Rule and SPM are great, but the billing method you choose should depend on your practice's specific needs and workflow.