Physical Therapists Guide to the Medicare 8-Minute Rule

Physical Therapists’ Guide to the Medicare 8-Minute Rule (“Rule of Eights”—to determine the number of units they should bill Medicare for the therapy services provided on a particular date of service)

The 8-minute rule helps determine how many billable units you as a rehab therapist may charge based on the time spent with the patient for the outpatient therapy services. Billable units (per the 8-minute rule) are computed in 15-minute increments once you cross the initial minimum of 8 minutes of providing service.

What are timed and untimed codes?

Physical therapy billing codes can either be timed codes or untimed codes, based on the service offered. The untimed codes are reported as a single unit for billing purposes, irrespective of the amount of time you spent with the patient. However, the timed ones are reported using the 8-minute rule, where you can bill multiple units in 15-minute increments (one unit = 15 minutes of direct therapy), based on the actual time you spent with the patient. As a therapist, you must provide one-on-one, direct therapy for a minimum of eight minutes (considered as a minimum threshold) to receive reimbursement for a time-based treatment code.

Guide to Medicare’s 8 Minute Rule for Physical Therapy

What is the 8 minute rule in physical therapy?

The 8-Minute rule, or rule of eights, helps therapists determine how many units they can bill to Medicare for the outpatient services they offer. Each timed code represents 15 minutes of treatment. Medicare adds up the total minutes of skilled, one-on-one therapy and bundles them into slabs of 15 minutes each If eight or more minutes of service were delivered you can bill for an additional unit. With fewer minutes of service than 8, Medicare does not reimburse you for another unit. Here is a simple chart that can help define the number of codes you can bill:

• 0 units- 0-7 Minutes
• 1 unit- 8-22 Minutes
• 2 units- 23-37 Minutes
• 3 units- 38-52 Minutes
• 4 units- 53-67 Minutes
• 5 units- 68-82 Minutes
• 6 units- 83-97 Minutes
• 7 units- 98-112 Minutes
• 8 units- 113-127 Minutes

A lack of understanding about the rule of eight can often cause erroneous billing and hence reimbursement delays or denial. Here are some of the many types of services that qualify for timed billing:

• Patient readiness assessment for interventions
• Patient progress assessment
• Completing documentation in the presence of the patient
• Communication, Education of the patient

Understanding the 8-minute rule is crucial for you to bill correctly. The service-based codes do not use the time-based unit for billing so it does not make a difference if the evaluation is done in 15 or 45 minutes whereas the timed-based codes allow variable billing that is based on 15-minute increments.

Billing-related compliance can be complex especially if you don’t have a background in business or finance. The 8-minute rule can be confusing, particularly when you offer more than one service in a single visit, and each service has its separate code. A professional medical billing services firm can help you confidently describe and defend the minutes spent assessing and managing a patient. With a little help from professionals you can maintain a full-proof system that ensures you get reimbursed for the maximum amount of all your services.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com