Medicare 8-minute Rule Chart

What is Medicare's 8-Minute Rule?

The Medicare 8-Minute Rule is a billing guideline established by the Centers for Medicare & Medicaid Services (CMS) for outpatient therapy services. This rule dictates how many units therapists can bill Medicare for time-based, or "timed," services, ensuring that patients receive at least 8 minutes of treatment to bill for one unit of service.

The rule is imposed to standardize billing practices and prevent overbilling for services that are not provided in substantial durations.

How does the Medicare 8-Minute Rule work?

The 8-Minute Rule affects services that are billed in 15-minute increments, known as "units." For a service to be billable, the therapist must provide direct treatment for at least eight minutes. A service that lasts seven or fewer minutes does not count.

If more than one service is provided in a session, the total time spent on all timed services is combined to determine the number of billable units. For example, if a therapist provides 10 minutes of therapeutic exercise and 12 minutes of manual therapy, the total time is 22 minutes. According to the 8-minute rule, this can be billed as two units because each service meets the minimum 8-minute requirement.

This caveat also means that even if a service is less than eight minutes long, it can still count toward the total. If the therapeutic exercise is five minutes long and the manual therapy is four minutes long, the total is still eight or more minutes, so it can be billed as one unit.

Additional guidelines include using appropriate billing modifiers to indicate specific circumstances, such as services performed by a therapy assistant or services exceeding the Medicare therapy threshold.

How to calculate billable units?

To calculate billable units under the Medicare 8-Minute Rule:

1. Add total time: Sum the minutes spent on all timed services.
2. Separate whole units: Identify how many full 15-minute units can be billed.
3. Combine remainder minutes: If leftover minutes (mixed remainders) from different services total 8 minutes or more, they can be combined to form an additional unit.
4. Bill additional unit: If 8 or more minutes remain after accounting for whole units, bill for one more unit.

What are time-based codes?

Time-based codes, also known as procedure codes, are used in billing to represent the amount of time a healthcare provider spends delivering a specific service. In contrast, service-based units are billed as a single unit regardless of the time taken.

In terms of outpatient services, time-based codes are essential for accurately billing services such as physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP), which are measured by the duration of treatment provided.

Billing modifiers for time-based codes

When submitting claims for time-based services, it's important to use billing modifiers to provide additional information about the service. Here are some common billing modifiers used in PT, OT, and SLP billing:

• CQ/CO: Indicates services performed in part by a therapy assistant (PTA uses CQ, OTA uses CO). Applies when a PTA or OTA provides at least 10% of the service.
• GA: Indicates that the provider has an Advanced Beneficiary Notice (ABN) on file for a service that Medicare does not consider medically necessary.
• GO: Indicates that an OT has provided services, usually in an inpatient or outpatient therapy setting.
• GN: Indicates that an SLP has provided services, usually in an inpatient or outpatient therapy setting.
• GP: Indicates that a PT has provided services, usually in an inpatient or outpatient therapy setting.
• KX: Indicates that the client has exceeded the Medicare therapy threshold, but services remain medically necessary.
• XP: Used when a service is billed separately because it was performed by a separate provider.
• 22: Used for increased procedural services when the provider goes beyond what the code usually entails.
• 52: Used when the provider has reduced or eliminated the scope of a billed service.
• 59: Designates the billing of services that are not usually provided together, like NCCI edit pairs.
• 95: Indicates services provided through telemedicine (live audio and/or video).

Common time-based CPT codes

Here are some common time-based CPT codes for established and new patient visits. You can use this list as a quick reference, too.

Established patient visits:

• 99212: 10-19 minutes
• 99213: 20-29 minutes
• 99214: 30-39 minutes
• 99215: 40-54 minutes

New patient visits:

• 99202: 15-29 minutes
• 99203: 30-44 minutes
• 99204: 45-59 minutes
• 99205: 60-74 minutes

Prolonged services:

• 99417 x 1 + 99215: 55-69 minutes
• 99417 x 1 + 99205: 75-89 minutes
• 99417 x 2 + 99215: 70-84 minutes
• 99417 x 2 + 99205: 90-104 minutes
• 99417 x 3 + 99215: >84 minutes
• 99417 x 3 + 99205: >104 minutes

(For each additional 15 minutes, add another 99417)

Now, this is just a quick guide. If you want to look at the nitty-gritty of billing, check out our ultimate guide for billing.

Benefits of having an 8-minute rule chart template

Having an 8-minute rule chart template offers numerous benefits for healthcare professionals, particularly those involved in outpatient therapy services. Here are some key advantages:

• Simplifies the billing process: The template provides a clear and concise reference for calculating billable units, making it easier for therapists to bill accurately and efficiently.
• Ensures compliance: By adhering to the Medicare 8-Minute Rule, the template helps therapists stay compliant with billing regulations, reducing the risk of errors and potential audits.
• Maximizes reimbursement: By accurately calculating billable units, therapists can ensure they are fully reimbursed for the services provided, optimizing revenue for the practice.
• Saves time: The template streamlines the billing process, allowing therapists to spend less time on administrative tasks and more time focusing on patient care.
• Enhances documentation: The template serves as a valuable tool for documenting treatment times and billing codes, facilitating clear and organized record-keeping.
• Improves training: For new therapists or billing staff, the template can be used as a training tool to understand the nuances of time-based billing and the Medicare 8-Minute Rule.
• Increases transparency: By using the template, therapists can provide transparency to patients about the billing process and the duration of services, fostering trust and communication.

Overall, an 8-minute rule chart template is a valuable asset for any therapy practice, contributing to smoother operations, better financial management, and enhanced patient satisfaction.