Everything You Need to Know About the Medicare 8-Minute Rule | WebPT (2024)

FAQs

What is the 8 minute rule for Medicare? ›

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.

The AMA's rule of eights

For example, if you bill for 8 minutes of therapeutic exercise (97110) and 8 minutes for manual therapy (97140), you would bill two separate physical therapy billing units under the Rule of Eights (1 unit of 97110 on one line and 1 unit of 97140 on the second line).

The 8 minute rule helps therapists determine the number of units they can bill for a specific timed service. Service units for therapy occur in 15-minute increments. For example, a 30-minute session would be billed and reimbursed for two units.

The rule of 8s follows the same principles of the 8-minute rule, but it is calculated per service. In other words, a clinician needs to perform half the service time outlined in a timed code before she can bill for one unit of that code.

The 8-Minute Rule applies to Medicare in addition to a swathe of other plans (including some that fall under federal, state, and commercial purview). That said, to determine the requirements for individual payers, it's best to contact the payer directly.

This 8-month period is called a Special Enrollment Period (SEP). If you enroll in Medicare Part B during this SEP, you will not be required to pay a late enrollment penalty.

Medicare introduced the 8-minute rule in 1999 and fully adopted it in 2000. Put simply, the 8 minute rule dictates that healthcare providers must provide at least eight minutes of direct, face-to-face patient care to bill for one unit of a timed service. Anything less than that doesn't qualify as billable time.

So even when the infants are sleeping, they're very keen on what parents are doing." Kuroda reiterated that walking with an infant in your arms for five minutes continuously is crucial — then it can be followed by five to eight minutes of sitting with the child in your arms in order to "stabilize their sleep."

One of the most confusing aspects of Physical Therapy billing is Medicare's 8 Minute Rule for time-based codes. Physical Therapy billing codes are either timed codes or untimed codes for billing purposes. Untimed codes are reported as one unit per day. Timed codes are reported using the 8 Minute Rule.

The key feature of the 8-minute rule—and the origin of its namesake—is that a therapist must provide direct treatment for at least eight minutes to receive payment from Medicare for a time-based (or constant attendance) CPT code.

What is the difference between SPM and the 8 minute rule? ›

8 minute rule is only applied to medicare payers, so most of the commercial payers don't follow the medicare guidelines and this is where SPM comes into play. It goes way similar to 8 minute rule but the main difference between the two is that under SPM a therapist cannot bill for leftover or remainder minutes.

To be clear, that doesn't preclude you from billing for both group therapy and individual therapy on the same day—so long as the group session is clearly distinct or independent from the individual services and you use modifier 59. (For more information, check out this modifier 59 post.)

Under the 8-Minute Rule, you can bill Medicare for a single “billable unit” of service if it lasts at least eight minutes (up to 22 minutes). After that, you calculate billable units in 15-minute increments. Medicare rolled out the 8-Minute Rule in April 2000.

The two-midnight rule is used when a clinician believes that a Medicare beneficiary needs hospital care that will likely eclipse two midnights—requiring inpatient care instead of cheaper outpatient care, Regan Tankersley, an attorney at the law firm Hall Render who advises healthcare systems, told Healthcare Brew.

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR.

The 60% Rule is a Medicare facility criterion that requires each IRF to discharge at least 60 percent of its patients with one of 13 qualifying conditions.

The 8-minute rule was introduced into the physical therapy billing process in the year 2000 and is utilized by outpatient physical therapy services, allowing a physical therapy practitioner to bill for services as long as they see their patient for at least eight minutes, which would serve as one unit of therapeutic ...

Your plan must tell you each year if your non-Medicare drug coverage is creditable coverage. If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare drug coverage later.