Let’s understand the Medicare 8-Minute Rule for Physical Therapy Billing with Zee Medical Billing. In this providers must treat patients for at least eight minutes to receive Medicare reimbursement.The 8-minute rule states that you must provide treatment for at least eight minutes to receive Medicare reimbursement. Using the “rule of eights,” billing units that are normally based on 15-minute increments spent with a patient can be regulated. One must complete at least eight minutes of treatment be paid for one 15-minutes increment. For example, after completing 17 minutes of treatment, Medicare would be billed for 15 minutes or one unit. However, if you completed 23 minutes of treatment, Medicare would be billed for two units of treatment. Even if you spent 23 or 30 minutes with the patient the bill would still be for two units.
What Is Medicare’s 8-Minute Rule?Physical therapy billing guidelines for Medicare and Medicaid services include a section about how much time you must spend with a patient for it to be “bill-worthy.” Medicare physical therapy billing works in increments of 15. So what are you supposed to do when your treatment only takes 13 minutes to complete? That’s where the eight-minute rule comes in. You only have to spend eight minutes with a patient to be able to bill for one “15-minute” unit. However, if you spend 16 minutes with a patient, you’ll still only be able to bill for one unit. You’d have to spend 23 minutes with a patient to be able to fall into the two-unit bracket.
How Does Medicare 8 Minute Rule for Physical Therapy Work?
Guidelines for when Medicare 8-minute Rule for Physical Therapy AppliesMedicare’s 8-minute rule is a condition that applies to time-based CPT codes for outpatient services. The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight but less than 22 minutes. A billable “unit” of service refers to the time interval for the service provided. Under the 8-minute rule, each unit of service consists of 15 minutes. Billable units for the eight-minute rule would look something like this: If you perform physical therapy with a patient for only five minutes, the timer resets before you begin the next activity. You cannot bill Medicare until you have worked with a patient on one activity for at least eight minutes.
Current Procedural Terminology (CPT) CodesCPT codes describe the procedures and services you are performing to billing agencies and insurance companies. They were created by the American Medical Association in 1966 to simplify and standardize reporting of procedures. There are three code categories and each code consists of five characters:
- Category 1 → services and procedures
- Category 2 → performance management
- Category 3 → emerging and experimental services and procedures
Category one contains:
- Anesthesia (numbers 01000-01999)
- Surgery (numbers 10021-69990)
- Radiology (numbers 70010-79999)
- Pathology and labs (numbers 80047-89298)
- Medical services/procedures (numbers 90281-99607)
- Evaluation and management services (numbers 99201 through 99499)
Category two contains:
- Composite measures (numbers 0001F-0015F)
- Patient management (numbers 0500F-0584F)
- Patient history (numbers 1000F-1505F)
- Physical exams (numbers 2000F-2060F)
- Diagnostics/screenings (numbers 3006F-3776F)
- Therapy/Preventive/Other interventions (numbers 4000F-4563F)
- Patient safety (numbers 6005F-6150F)
- Structural measures (numbers 7010F-7025F)
- Nonmeasure code listing (numbers 9001F-9007F)