In the last few years, the billing system for therapy prescribed by the Medicare administration has changed dramatically. The newest system breaks up each therapy appointment into distinct eight minute blocks for the purpose of billing with the goal of making care more value based and reflective of time spent with each patient. The 8-Minute Rule is often misused by therapists due to a variety of common mistakes. The purpose of this article is to explain all you need to know about the rule in order to avoid making the same mistakes again.
How does the 8-Minute Rule work?
All types of therapists, such as occupational therapists, physical therapists, and speech therapists, use the 8-minute rule to determine how many units they should bill Medicaid for outpatient services.
There are 15 minutes of treatment represented by each timed code. For treatments that do not fall neatly into 15-minute increments, the 8-minute rule is used to determine the number of units you should bill.
For Medicaid reimbursement using a time-based treatment code, you must provide therapy for at least 8 minutes in order to be reimbursed.
Using CPT codes to describe services
When billing Medicaid, therapists use CPT codes to indicate which services were provided. A service-based CPT code denotes that an examination, procedure, or treatment has been provided, such as physical therapy. Regardless of the length of time taken for these services, they cannot be billed more than once.
Calculating timed codes in minutes
Timing codes, however, are another matter. In cases where a provider provides only one service per day, they should not bill for less than eight minutes of service. If the treatment lasts more than or equal to 8 minutes through and including 22 minutes, providers bill a single 15-minute unit based on the same day's timed CPT code.
To remind yourself how to bill for intervals up to eight units, here is a cheat sheet:
These codes indicate the amount of time the patient spends with the therapist in one-on-one sessions. Exercises used in physical therapy are included in this category. CPT codes based on time can be billed in increments of 15 minutes, unlike service-based codes. A unit of therapy would be equivalent to 15 minutes.
For a time-based treatment code to be reimbursed, a therapist must provide direct one-on-one therapy for at least 8 minutes.
In the event that only one service is provided in a day, you should not charge for services less than 8 minutes long. The total number of units that can be billed is limited by the total treatment time if you're billing more than one timed CPT code per calendar day.
Remainders of mixed quantities
According to CPT guidelines, each timed code should represent 15 minutes of treatment. It is important to note, however, that not all treatments will be divided neatly into 15-minute segments for you. A rule of 8 minutes applies in these cases. A therapist must provide at least 8 minutes of continuous therapy to bill for a unit of time-based CPT code, which normally represents 15 minutes.
It's tricky to handle mixed remainders. In the case where you divide a total of timed minutes by 15 and the remainder includes leftover time from several services (codes), you have mixed remainders. In that case, you can bill an additional unit of the service (code) with the longest duration if the total of the remainder equals 8 (or more).
As an example:
As a result, 38 minutes equals three units.
By dividing total time by 15 and calculating the remainders, the extra unit can be assigned with more accuracy.
Divide 38 by 15 to find out which service is required to be billed an additional unit. Each code is assigned one unit. A second unit is billed for the remaining 8 minutes, since manual therapy covers more of the remaining time. In addition, Medicare's 8-Minute Rule cheat sheet (illustrated above) already accounts for remainders, but this formula is convenient for quick reference.
Mistakes to avoid
The following are some common mistakes to avoid before you put the 8 minute rule into practice:
Medicaid Rules for billing other payers
All payers are not subject to the 8-minute rule. The 8-minute rule has been adopted by some private insurance companies, but not all. If you are billing payers who do not follow Medicaid's guidelines, make sure you are billing in accordance with your agreement with that payer.
Various Remainder Mix-ups
There is no allowance for mixed remainders from private insurance companies, so you can only bill if an individual activity takes more than 8 minutes.
PatientStudio has all the tools you need to ensure that your billing practices align with current regulations and best practice, both for your 8-minute rule patients and others. Click here to schedule your free demo to see how easy the billing process can be.