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The 8-minute Rule of therapy Billing

Meaning of CPT

The 8-minute rule therapy allows therapists to decide the number of units they can calculate or bill in a specific time. In addition to 8-minute rule therapy, therapists should know how it starts, how it works, and the difference between time-based and service-based codes.

What is 8-Minute Rule Therapy?

The 8-minute rule is used by therapists like physical therapists and speech therapists to know how many units they should bill for any outpatient service they provide.

Each time code is assumed to be 15 minutes of treatment. Since all the treatments can’t be perfectly divided into 15 minutes, so 8-minute rule exists to determine how many units you should bill in those cases. 

It is known as the 8-minute rule because it is the min. length of treatment you must provide to get reimbursement from Medicaid.

Why is it Important?

Getting accurate payments are crucial for doctors and healthcare service providers. The 8-minute rule helps them make sure that the amount of service they’re charging is right.

Fair Payments: The Rule makes sure that therapists get paid for their time helping patients.

Being Honest and Loyal:It helps building trust and is a sign of honest billing between a patient and service providers.

Better Care: Patient gets better care with it and proper attention from specialist.

When Does the 8-Minute Rule Begin?

In the 8-minute rule, the timer starts when you start providing your services. Don’t forget that collecting the information, assessing it, and teaching the patient are part of these services.
And when it comes to techniques, the clock starts at different points depending on service. For example, for surgical procedures, the clock begins when the provider starts performing the procedure.

On the other hand, for diagnostic tests, the clock starts when the provider initiates the service.

How Does 8-minute Rule Work?

According to the Centers for Medicare & Medicaid Services (CMS), “When billing for a single timed CPT code in a single day, providers bill a single 15-minute unit for every treatment lasting more than or equal to 8 minutes, up to and including 22 minutes. When one modality or procedure lasts longer than or equal to 23 minutes, up to and including 37 minutes, in a single day, two units should be paid.

The time spent with the patient can be converted into billable units using this simple table:

Time Delivered Billable Units
Less than 8 minutes 0 Units
8 to 22 minutes 1 Units
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

After treating patient, you can measure the units in following steps:

Step 1: Add all the time together which is spent on providing timed service to check how many units you can bill in total.

Step 2: Separate each whole 15-minutes unit using CPT Code (Example: two units of 97761 = 30 minutes service)

Step 3: Here’s when things get more mixed, if there are any minute that have not been converted into units it means these are “Remainder Minutes”. Add whatever mixed remainders you have to any incomplete whole unit.

Step 4: In case there are still 8 mixed remainders left of a service, bill for another single unit. till CMS allows one unit to be billed for any service that is at least 8-22 minutes long, the remaining 8 minutes selected for CMS’s interpretation of the “8-minute rule.”

Application of the 8-Minute Rule in Therapy Services
Service-Based CPT Codes

CPT codes are used to identify which services a patient has received when therapists charge Medicaid for services provided. A service-based CPT code refers to the provision of services such as physical therapy examinations or basic outpatient procedures and treatments. Regardless matter how much time is required, these services cannot be billed for more than one unit.

Examples of common service-based CPT codes include:

Time-based CPT Codes

As you probably know, these codes are used to get the amount of time a patient invests in one-on-one procedures with specialists. These cover all forms of attendance such as physical therapy practices.

Far apart from service-based CPT Codes, time-based CPC Codes can be billed as many units in 15-minute increments. This means that a single unit would be equivalent to fifteen minutes of therapy. To be compensated for a time-based treatment code, a therapist must conduct direct, one-on-one therapy for a minimum of 8 minutes.

You should not charge for services rendered for less than 8 minutes if there is just one service rendered on a given day. However, the total treatment duration limits the number of units you can bill if you are invoicing more than one timed CPT code in a given calendar day.

Examples of time-based, therapy CPT codes include:

The 8-minute rule is important for both therapist and patient, it makes sure that patient received necessary amount and prevented overbilling by therapist. 8-minute rule can be complex and understanding it is important for providing best care.

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Isaac Smith

My name isaac and I am a revenue cycle management strategist with more than 10 years of experience. I completed my Bachelor in Medical and Health Services Management from Kean University and have worked extensively in the field of healthcare.

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