The 8-minute rule is an important tool for physical therapists to keep track of billing time. Medicare reimburses for treatments based on the number of billable units. The rule is a simple guideline, but there are subtle nuances that can make it difficult to understand. The reason the 8-minute rule is so important is because it helps prevent therapists from overcharging patients. Essentially, it means that a patient can’t receive more than eight minutes of physical therapy treatment.
The 8-minute rule applies to direct contact therapeutic services, such as massage, or acupuncture. During a session, the provider must spend an average of eight minutes on each patient in order to qualify for billing under time based CPT codes. Alternatively there are service based CPT codes which do not contain or require a specific time period that a therapist must spend with a patient. In order to better understand the 8 minute rule, let’s first delve deeper into both service based and time based CPT codes.
Service Based CPT codes
Service based physical therapy treatments are those that are billed under one CPT code regardless of how long the treatment lasts. Because there is no measurement of time associated with the service based treatment, there is no reason for the eight-minute rule to apply to these services.
Some common service based CPT codes for physical therapy:
- physical therapy evaluation (97161, 97162, or 97163) or re-evaluation (97164)
- hot/cold packs (97010)
- electrical stimulation (unattended) (97014)
Time based CPT codes
Timed CPT codes in physical therapy are based on the amount of time the therapist spends with the patient. If the therapist provides treatment for 15 minutes, you can bill it as one unit. For the purposes of billable units according to Medicare as well as most insurance providers, all the skilled therapy documented during the day is divided by 15 to determine the number of units that can be paid. If there is a remainder of time left that is greater than eight once the time is divided, the therapist can then bill one additional unit.
Some common time based CPT codes include:
- therapeutic exercise (97110)
- therapeutic activities (97530)
- manual therapy (97140)
- neuromuscular re-education (97112)
- gait training (97116)
- ultrasound (97035)
- iontophoresis (97033)
- electrical stimulation (manual) (97032)
For timed physical therapy CPT codes, the amount of time spent on a single therapy service cannot exceed the number of units in that day’s treatment. If the number of hours spent in a therapy session is greater than the total billed time, the therapist can bill more than one therapy unit per day.
This rule is very similar to the 8-minute rule. A therapist can bill for two units of 98116 in a single visit if the session lasts at least eight minutes. If a patient receives two units in a single session, the therapist can bill for two of their ex-sessions. The therapist will need to document the second unit in the presence of the patient. There are also specific rules and regulations for how long a session should last.
What does the CMS manual say about the eight-minute rule?
The CMS manual outlines the eight-minute rule in detail. The rule states that a therapist can bill for more than one unit if they provide skilled treatment for less than eight minutes. While there are exceptions to this rule, it generally applies to treatment that lasts less than eight minutes. In these instances, the therapist can bill for two units for a single session. If the patient completes only two units, the therapist can still bill for both services.
When to use the eight-minute rule
The 8-minute rule should be followed in physical therapy billing, but not under every circumstance. For example, an initial exam can take 25 minutes. The staff may ask questions and examine the affected area, and may perform a physical therapy exercise. Because an initial exam is considered a service based procedure, the 8-minute rule should not be followed. It is important to know the CPT rules for billing to avoid any legal issues in the future. You should also familiarize yourself with the lingo in order to avoid any misinterpretation.
By contrast, if the treatment being provided does fall under a timed CPT code category, it is extremely important to document each of the units spent with a patient. If units are not recorded in accordance with the eight-minute rule it is extremely likely that your practice will not receive reimbursement from either Medicare or private insurance. In addition, it is impossible (and illegal) to record units of time after the date of service.
The 8-minute rule for billing is important for physical therapists. It helps them determine the amount of time it takes for each session. The rule also makes it easier to work through the intricacies of billing for treatment that has been provided. It is very beneficial in billing for a small business to use a good therapy management tool like the one included with PatientStudio to help you understand the rules for billable minutes.
The eight-minute rule for billing for physical therapy is an important tool for assessing the time required to complete an effective treatment. While it can be a tricky math exercise, it will help a physical therapist to ensure that they’re not billing for more than their hourly rate. In the end, this method helps them to charge more accurately and avoid underbilling. It’s a win-win situation for all parties.