What is the 8-Minute Rule?

The 8-Minute Rule or “Rule of Eights” can be tricky if you don’t know the basics. Unfortunately, this “transaction” is a little more complex than purchasing your morning coffee.

The 8-Minute Rule was established because, according to CPT guidelines, each timed code represents 15 minutes of treatment. As you may realize, not every treatment time for these codes will divide into exact 15-minute blocks. As a result, the 8-Minute Rule was born! This rule only applies to Medicare unless other insurances specify that they follow the same guidelines as Medicare.

How does it work?

According to this WebPT article, “In order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes." In other words, Medicare adds up the total minutes of skilled, one-on-one therapy (direct time) and divides the resulting sum by 15. If eight or more minutes are left over, you can bill for an additional unit. But if seven or fewer minutes remain, Medicare will not reimburse you for another full unit, and you must essentially drop the remainder. To give a simple example, if you performed manual therapy for 15 minutes and ultrasound for 8 minutes, you could bill two direct time units.”

When working with untimed codes, things are a bit different. To figure out how many total units you should bill, you should always start by calculating your total time (i.e., direct time + unattended time) (WebPT). You can check your total against the chart below to see the maximum total number of codes you can bill:

http://www.ptbillingservices.com/the-8-minute-rule-how-does-it-work/

Don’t forget that when you calculate your total minutes of treatment, you can only bill for the timed units. For example, if you provide 30 minutes of (attended) exercise and 30 minutes of (unattended) electrical stimulation, your total treatment time is 60 minutes. According to the chart above, you could bill for 4 units, right? Wrong, the unattended time does not count here. You can only bill for 2 units in this scenario. Medicare does this because it only reimburses for what is considered to be “skilled” PT time.

If you’re unsure which codes to use for untimed and timed billing, or if you want to see the coding exceptions to the 8-Minute rule, this article may be helpful to you.

Billing and Medicare compliance can be nerve-racking, especially if you don’t have a background in business or finance. The good news is—with a little help from the right people, you can maintain a foolproof system that ensures you’re getting reimbursed for the maximum amount of all your services.