How Medicare’s 8-Minute Rule Works

Please note that this article contains information that is only relevant to American clinics.

 

Many American clinics that regularly submit claims to Medicare are well acquainted with the 8-minute rule. But for those of you that aren’t familiar with how Medicare’s 8-minute rule works, we’ve put together this article especially for you. To learn more, continue reading:

 

What is the 8-minute rule?

 

The 8-minute rule is a stipulation that allows you to bill Medicare insurance carries for one full unit if the service provided is between 8 and 22 minutes. As such, this can only apply to time-based CPT codes. But, the 8-minute rule doesn’t apply to every time-based CPT code, or every situation. There are a number of conditions that must be met in order for you to bill that code.

 

Examples of when the 8-minute rule applies

 

I. If you perform an initial evaluation that lasts 35 minutes and a 7-minute therapeutic exercise, you can only bill one units for the initial evaluation.

 

Why doesn’t it apply here? Because the initial evaluation is not considered a time-based fee code, and the 7-minutes of therapeutic exercise didn’t surpass the 8-minute threshold. In order to successfully bill for the therapeutic exercise, the provider needs to spend a little more time with the patient.

 

II. If you perform 30 minutes of therapeutic exercise, 15 minutes of manual therapy, and 9 minutes of ultrasound, you need to add up the total time of the one-on-one therapy provided to determine how much you’ll be able to bill for. In this example, the provider has seen the patient for a total of 54 minutes, and are eligible to bill a total of 4 units. The time spent performing the ultrasound was greater than 8 minutes, so they’re able to bill for one full unit.

 

If you’re ever in doubt, you can use the chart below to determine how many units you’re able to bill by calculating the total amount of time spent performing time-based fee codes:

 

medicare-8-minute-rule

 

Learn more about the 8-minute rule

 

If you’re interested in learning more about the 8-minute rule, check out the video below: