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What Is the Medicare 8-Minute Rule?

The 8-minute rule is Medicare’s way of calculating for billing physical therapy and outpatient services. It allows providers to bill for one unit of service if a session is at least 8 minutes long. Between the 8-minute mark and 22-minute mark, providers can officially bill for one 15-minute unit of time. This rule applies to in-person visits, so you need to be in direct contact with your therapist for that amount of time.

How Medicare Billing Affects You

As a beneficiary, the 8-minute rule is important to know about because it affects how you might be billed for a service. For example, even if you saw your doctor for a quick 10-minute visit, this can still be billed as one 15-minute unit because the visit lasted over 8 minutes.

While this sounds unfair, it can also work to your advantage. For example, if you visited with your doctor for a full 22 minutes, this still only counts as one 15-minute billable unit. This is also true if you received multiple services during a single visit. These are added together rather than counted separately, which can help reduce the number of units for which you’re billed.

How Does the Medicare 8-Minute Rule Work?

Medicare’s 8-minute rule mainly applies to outpatient rehabilitation services providing in-person care. For example, it might apply when you’re seeing:

  • Physical therapists
  • Occupational therapists
  • Speech and language pathology therapists

This rule applies specifically to timed billing codes listed in the Healthcare Common Procedure Coding System (HCPCS). Your provider selects an HCPCS code for every service they provide (for billing purposes), and some codes require the provider to enter how much time the service took.

Because of this setup, you might be billed for several different services during the same visit. For example, your therapist might bill you a set fee for your initial assessment since this is not a time-based code. However, if you also had therapeutic exercise (a time-based code) at this visit, you could receive a bill for that based on how long it took.

Here’s how many 15-minute increments Medicare allows providers to bill based on the time they spent with the patient:

  • 8 to 22 minutes: 1 unit
  • 23 to 37 minutes: 2 units
  • 38 to 52 minutes: 3 units
  • 53 to 67 minutes: 4 units
  • 68 to 82 minutes: 5 units
  • 83 to 97 minutes: 6 units
  • 98 to 112 minutes: 7 units
  • 113 to 127 minutes: 8 units

See It In Action

Imagine you had an appointment where you received therapeutic exercise for 24 minutes and underwent neuromuscular re-education for 23 minutes. Rather than count each service as two 15-minute increments because they’re both over 22 minutes, Medicare instead adds up the total timed services provided. In this case, it adds up to 47 minutes.

Using the time scale, the 47 minutes equates to three billable units. When billing, your provider should assign two units to the therapeutic exercise service because it lasted longer. Then, they would bill neuromuscular re-education for one unit.

This example is how, in some cases, you might be billed for a service if it’s under 7 minutes. If you received other timed services that day, the 7-minute service could be added to the total and billed for one unit.

Time vs. Service Billing

Every service, supply, procedure, or product a provider offers is coded in the HCPCS. When billing for a service, a provider chooses the appropriate code from the HCPCS and sends it to Medicare to receive payment.

There are two types of classifications for these codes: service-based and time-based. Service-based codes are billed the same regardless of how long a visit takes. They typically include things like evaluations, supplies, or products. Time-based codes, on the other hand, are billed based on how long a certain procedure or service takes. Medicare uses the 8-minute rule for time-based billing codes.

Common Time-Based Care

  • Therapeutic exercise: These are movements you might perform to restore your muscular and skeletal function.
  • Manual therapy: Manual therapy is when a therapist applies pressure and passive movement to help improve a joint’s range of movement.
  • Ultrasound: An ultrasound is an imaging test that uses sound waves to look inside the body and can diagnose soft tissue problems.
  • Neuromuscular re-education: You use this type of therapy to improve communication between the brain and body and improve normal body movement.
  • Wheelchair management: Wheelchair management is a process that helps wheelchair users learn the right ways to avoid pressure points, contractures, and other issues.

Common Service-Based Care

  • Physical therapy evaluation: In a physical therapy evaluation, a physical therapist examines and tests your body’s movement patterns to determine if there’s a problem. They also create a plan of care.
  • Oral speech device evaluation: During this evaluation, a speech and language pathologist can determine if you need a voice prosthetic to help improve your speech.
  • Hot/cold packs: Your doctor can provide you with hot and cold packs to relieve pain and swelling.
  • Speech-language treatment: In speech-language therapy, you work on problems that might be causing issues with talking, eating, or swallowing.
  • Ultraviolet therapy: Ultraviolet therapy involves using a strong light on certain areas of your skin.

Documentation for Health Practitioners

Providers need to follow strict protocols to have Medicare reimburse them for timed billing services. Medicare wants to make sure providers do not lie about how much time they spend with patients. Therefore, it requires providers to document these three pieces of information:

  1. The total time the provider spent servicing the patient
  2. The start and stop times for each code being billed
  3. An in-depth narrative about the services being provided

In particular, practitioners need to make sure they’re calculating the billable time for each code correctly. If only one service is being provided, that’s easy enough. However, for visits with multiple services, providers need to add up the total time they spent working with the patient. This is the number they can use to determine how many billable units there are. From there, they can then break down how many units to attribute to each service based on start and stop times.

What This Means for You

As a beneficiary of physical therapy services, understanding Medicare’s 8-minute rule might be useful when looking at your next bill. You can look at each code and ensure the provider billed it for the correct number of units. If there’s an error, such as having been billed for two units of therapeutic exercise instead of one, you can feel confident fighting the bill until your doctor’s office corrects it. Ultimately, understanding this rule empowers you to become more involved in your healthcare experience.

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