Are you a therapist struggling to navigate a time-based service code and following through the 8-minute rule? Don’t worry because the billing specialists working at MediBillMD have comprehensively penned this detailed guide for you!
This guide explores what the Medicare 8-minute rule entails and how it works. We will explain the rule’s application via some applicable scenarios. Also, included within this guide is the 8-minute rule Medicare chart so that while calculating and reporting the therapy services, you can speed up the procedure and reduce the chances of errors.
So, without further ado, let’s get right into the details!
What is the 8-minute Rule?
The Centers for Medicare and Medicaid Services (CMS) is responsible for managing Medicare’s 8-minute rule. It applies to all time-based CPT codes, especially for outpatient care procedures, such as physical therapy.
This rule was introduced in 1999 and became effective in 2000. The 8-minute therapy rule enables healthcare providers to bill one unit if at least 8 minutes of direct contact takes place with the patient during the care service.
For the unversed, a billable service unit is also known as the service time interval, while each unit consists of 15 minutes of service time.
How Does the Medicare 8-Minute Rule Work?
The Medicare 8-minute rule can be confusing, especially when you have to bill timed procedures with untimed codes. Thus, you can refer to the 8-minute rule Medicare chart below to calculate the time spent providing direct care to the patient and bill its units:
| Service Time Spent | No. of Units |
|---|---|
| 0-7 minutes | 0 unit |
| 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 |
In case you are wondering how we made this chart and whether or not you can translate the time spent with patients into billable units yourself, here are two ways to think about it.
Long Division
Divide the time you spend providing patient care by 15, the standard time for one billable unit. Now, take the whole number from the answer and count the remainder. If the remainder is an eight or higher, add one unit to the quotient number, and you will get your total billable units.
For instance, if you spent 20 minutes on patient care and divided it by 15, you get a remainder of 5 (less than 8) and a quotient of 1. Thus, you do not add another unit to the quotient number and bill 1 unit only. However, many found this method tricky because you cannot use a calculator and have to do it the old-school way to get the remainder.
Start with Eight
Another way to calculate the eligible billable units as per the Medicare 8-minute rule is to use eight as your base for 1 unit and add multiples of 15 for higher units.
For instance, 8+15, or 23, is the starting point for two units. 8+30, or 38, will be the base where three units begin. Four units start at 8+45, or 53, and so on. Simply put, you are reporting 15 minutes spent providing patient care in 15-minute increments. However, instead of starting your count at 0, you should begin at 8.
Scenarios Where the Medicare 8-minute Rule is Applicable
Discussed below are some of the practical scenarios where the Medicare 8-minute rule applies:
Auditory Processing Assessment
Let’s assume a scenario where a caretaker brings a 10-year-old child for evaluation of a suspected auditory processing disorder. The healthcare provider conducts an initial 60-minute assessment of central auditory function, such as dichotic listening and speed-in-noise testing.
However, following this initial assessment, the audiologist spent an additional 30 minutes or two units of CPT code 92621 performing specialized tests to thoroughly investigate the child’s ability to process rapid auditory information and localize sound. While reporting CPT 92621, the 8-minute rule in Medicare will apply.
Iontophoresis
Consider a patient with chronic shoulder pain who encounters a physical therapist for iontophoresis treatment. The therapist applies the iontophoresis device to the shoulder for 20 minutes. The provider carefully monitors the patient’s comfort level and adjusts the current as required. Here, the practitioner billed 1 unit of the CPT code 97033 following the 8-minute therapy rule.
Aquatic Therapy
What happens when a patient with knee osteoarthritis participates in a 30-minute aquatic therapy session? The physical therapist instructs the patient to perform various exercises in the pool, including range-of-motion exercises, leg lifts, and water walking. Thus, the therapist will report two units of CPT code 97113 for accurate reimbursements following the 8-minute rule Medicare chart we shared earlier in this blog.
Orthotic Device Training
A physical therapist trained a patient on using a new ankle-foot orthosis (AFO). The therapist spent 30 minutes instructing the patient on demonstrating gait training techniques, adjusting the fit of the device, and properly donning and doffing the AFO. As per the Medicare 8-minute rule in physical therapy, two units of CPT code 97760 will be billed here.
Electroacupuncture
Assume a patient visits an acupuncturist to receive electroacupuncture treatment for chronic neck pain. The healthcare provider inserts fine needles into specific acupoints along the neck and applies electrical stimulation for 20 minutes. Thus, the acupuncturist will report this session as 1 unit of 97813 for accurate reimbursements under the Medicare 8-minute rule.
Summary
It is time to wrap up the blog! Here is a quick review of what we learned. We started the blog by explaining what the Medicare 8-minute entails and which organization is responsible for managing it. Besides, we discussed how it works, shared the 8-minute rule Medicare chart, and explained two methods for calculating the billable service units, including ‘long division’, and ‘start with the eight’ method.
We also shared some practical scenarios with timed CPT codes to show how this 8-minute rule applies. These included CPT 92621 for auditory processing assessment, CPT 97033 for iontophoresis, CPT 97113 for aquatic therapy, CPT 97760 for orthotic device training, and CPT 97813 for electroacupuncture.
We hope that these scenarios offered better clarity on billing time-based service codes. However, if you are having trouble receiving your rightful reimbursements, at MediBillMD, we are empowering therapists with tailored physical therapy billing services at an affordable rate. Connect with our billing specialist to discuss details!
