The 8 Minute Rule – How Does It Work?

Computing Billable Units

Now for the fun part, computing how many total units you can bill for and how many units you can bill for each individual code under the 8 Minute Rule.

First, you need to add up the total treatment time for timed codes (do not include the time spent treating for untimed codes, only include time spent treating for timed codes).

Then take the total treatment time for timed codes and look up the maximum number of units you can bill for on the 8 Minute Rule Table above.

For example, it you spent 38 minutes on timed codes and 30 minutes on untimed codes, the maximum number of units you can bill for is 3 units (38 to 52 minutes) based on the table. Remember, you only count the timed code minutes and you must ignore the untimed code minutes.

For the individual codes, you need to code based on the following rules:

1. If a service represented by a 15 minute timed code is performed in a single day for at least 15 minutes, that service shall be billed for at least one unit. If the service is performed in a single day for at least 30 minutes, the service shall be billed for at least two units, etc. You cannot count all minutes of treatment in a day toward the units for one code if other services were performed for more than 15 minutes (see examples 2 and 3 below).
2. When more than one service represented by 15 minute timed codes is performed in a single day, the total number of minutes of service determines the number of timed unites billed based on the 8 Minute Rule Chart. (See example 1 below).
3. If any 15 minute timed service is performed for 7 minutes or less on the same day as another 15 minute timed service that was also performed for 7 minutes or less and the total time of the two services is 8 minutes or greater, then you bill one unit for the service performed for the most minutes. This is correct because the total time is greater than the minimum time for one unit. The same logic is applied when three or more different services are provided for 7 minutes or less. (See example 5 below). The expectation is that a provider's direct patient contact time for each unit will average 15 minutes in length. If a provider has a consistent practice of billing less than 15 minutes for a unit, this should be highlighted for review.
4. If more than one 15 minute timed code is billed during a single calendar day, then the total number of timed units can be billed up to the maximum number of units allowed based on the total treatment time for that day (See examples 1 through 5 below).
5. The Medicare Benefit Policy Manual - Documentation Requirements for Therapy Services - indicates that the amount of time for each specific service provided to the patient is not required to be documented in the Treatment Note. However, the total number of timed minutes must be documented. If you are lucky enough to be using an EHR or EMR system, most of this should be computed automatically for you to make sure you do not over-bill for each visit.

There is one exception to the timed codes for codes 97545 and 97546. These specialized codes are used for rehabilitating a worker to return to the job and the expectation is that the entire time period specified for 97545 and 97546 would be the treatment period.

The code 97545 is for the time period included in the first 2 hours and the code 97546 includes the time period for each additional hour (after the first 2 hours). Normally these codes are used to report services to a patient's Workers Compensation program and are only rarely used for Medicare.

Examples

Here are some examples on how to count the appropriate number of units for the total therapy minutes provided using the 8 Minute Rule:

Example 1:

If you look up 47 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). Each of the codes were performed for more than 15 minutes so each should be billed for 1 unit. You should then assign the extra unit to 97712 since it was treated for the longer amount of time. So you bill for 1 unit of 97110 and 2 units of 97112

Example 2:

If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). Each of the codes were performed for more than 15 minutes so each should be billed for 1 unit. You can then assign the extra unit to either 97110 or 97712 since they were treated for the same amount of time. So you bill for 1 unit of 97110 and 2 units of 97112 OR 2 units of 97110 and 1 unit of 97112.

Example 3:

If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). You can bill 2 units of 97110 and 1 unit of 97140. You count the first 30 minutes of 97110 as 2 full units then add the additional 3 minutes of 97110 (33 minutes - 30 minutes) to code 97140 so you have 10 minutes of treatment time and can bill for 1 unit of 97140.

Example 4:

If you look up 49 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). You can bill for 1 unit of 97110, 1 unit of 97140, 1 unit of 97116 and NO units of 97035. Even though you performed 4 procedures, you can only bill for a maximum of 3 units so choose the procedures you spent the most time performing. You still need to document the ultrasound in your notes even though you could not bill for it.

Example 5:

If you look up 21 minutes on the table, you can bill for a maximum of 1 unit (8 to 22 minutes). You can bill 1 unit of 97110 OR 97112 OR 97140 since all three procedures were performed for the same amount of time. You are restricted to only 1 unit because of the total treatment time and all of the procedures still need to be documented in your notes.

For more information about coding for the Medicare 8 Minute Rule, you can reference the document - CMS CLM104005