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The 8 Minute Rule and How it Works For Physical Therapy Billing

8-minute-ruleBilling can feel like the most complicated thing about running a physical therapy practice. There are dozens of codes, both timed and untimed, that you must know. Then you must understand insurance company best practices, privacy laws, and a myriad of other things that pile on top of the time you spend on patient care. Medicare’s ‘8-minute rule’ for physical therapy doesn’t do much to alleviate the confusion. But it does make hiring a PT billing and collection service sound extra inviting.

Untimed Codes – 8-minute Rule Does Not Apply

While the 8-minute rule for physical therapy applies to timed codes, it’s important to understand the other codes – the untimed ones. Basically, anything you do for a patient that is considered ‘service-based’ is untimed, regardless of how much time you spend on it. It only counts as a single unit. This can include:

  • Heat/cold packs
  • Mechanical traction
  • Speech/sound production
  • Communication evaluation
  • … and a lot more.

If it takes you an hour to apply a heat pack, you bill for one unit. This is important to remember because the 8-minute rule does not factor in.

Timed Codes

Now we’re getting into the nitty gritty of what the physical therapy 8-minute rule is all about. As far as CPT codes go, timed codes have a unit of time associated with them, which is in their definition. These time-based codes are usually for one-on-one therapy services. Basically, the time you spend administering treatment to a patient. Some of these include:

  • Therapeutic exercise
  • Manual therapy
  • Neuromuscular re-education
  • Gait training
  • Cognitive skills development
  • … and much more.

Of course, a provider may allow billing in multiple units depending on how much time is spent on the service.

Types of Minutes

You want to concentrate, as much as possible, on being hands-on with your patients. This increases billable units. But be mindful of your reporting; you may need to prove the necessity of services. There are several types of minutes for timed billing:

  • Patient progress assessment and readiness for applied intervention.
  • Completing documentation of clinical assessment in the presence of the patient.
  • Communication or education of the patient, or caregiver or other provider, in their presence.

As explained earlier, these are for hands-on, one-on-one treatment during a patient’s visit.

The Dreaded 8-Minute Rule

Medicare’s 8-minute rule for physical therapy is used by CMS as a sort of billing algorithm. Other payers may also utilize this rule to help with payouts. Essentially, the rule of eights is a range of minutes to determine the total number of billing units. Here’s a chart to help you, and no, despite the name, they are not in 8-minute increments. We have no control over that. Sorry.

  • 8-23 Minutes = 1 Unit
  • 23-38 Minutes = 2 Units
  • 38-53 Minutes = 3 Units
  • 53-68 Minutes = 4 Units
  • 68-83 Minutes = 5 Units
  • 83-98 Minutes = 6 Units
  • 98-113 Minutes = 7 Units

The scale can’t be manipulated to your billing favor, alas. If a service takes an hour, for example, that’d be 4 units. You can’t split the treatment up into smaller chunks hoping for extra billable hours. This is why hands-on treatment – by you and not your staff – should begin at first contact, if possible.

…But There’s More

You need to provide a service for at least 8 minutes to bill for it. Aha! Hence the name ‘8-minute rule’. Medicare adds the total number of minutes for a date of service of each therapy provided, then divides by 15. If you have a remainder of minutes that equal 8, you can bill for 1 unit. If less, you’re out that time. However, you may have leftover minutes from other timed services. If so, you can add them together to meet Medicare’s requirements. This extra unit is added to the service that required the most time. That’s the PT 8-minute rule in a nutshell. Understanding it better can definitely help clear up some confusion. So can hiring a PT billing service to do the work for you and bring you more revenue, faster. Creative Commons Attribution: Permission is granted to repost this article in its entirety with credit to Jet PT Billing and a clickable link back to this page.

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