medicare 8 minute rule
medicare 8 minute rule
What the heck is the medicare 8 minute rule and why do providers even pay so much attention to it? Well to give a generic answer before the real one I’ll say this. It’s a rule that was made to keep money in your pocket and get the right amount of treatment if you do have to spend. Seriously!
The 8 minute rule dictates that in order to bill for each additional time-based code, you must spend at least eight minutes of each unit providing direct service to the patient. In other words, in order to bill for a 15 minute code, Medicare requires that the session be at least eight minutes long.
Here is the published guide for the range of minutes that are needed for billing 15-minute codes.
| 15 minute codes | Treatment Units |
| 1 unit | 8 minutes to 22 minutes |
| 2 units | 23 minutes to 37 minutes |
| 3 units | 38 minutes to 52 minutes |
| 4 units | 53 minutes to 67 minutes |
| 5 units | 68 minutes to 82 minutes |
| 6 units | 83 minutes to 98 minutes |
The first procedure must be at least 8 minutes, with each one thereafter billed in 15-minute increments. A minimum of twenty-three minute session is required in order to bill for two units. Only direct, face-to-face time with the patient is considered for timed codes.
For example, if a patient receives therapeutic exercise, this session is billed based on the CPT 97110 time-code. According to the eight minute rule, if the patient receives twenty minutes of therapeutic exercise as an outpatient, the hospital can only bill for one procedure, because you have not met the threshold for the next unit:
(15 minutes + 5 minutes) = 20 minutes
On the other hand, if he receives 25 minutes of out patient therapeutic exercise, then you will meet Medicare’s 8-minute threshold and can bill for two procedures instead of one:
(15 minutes + 10 minutes) = 25 minutes
