Medicare 8 Minute Rule

Physical Therapy

As compared to previous generations, people over the age of 65 now have a greater variety of Medicare insurance plans to choose from. More than twenty-five inexpensive Medicare options are available to most people, each with its own set of premiums, co-payments, and partnerships with pharmacies and medical providers to consider. Due to the large number of alternatives accessible, you must consider all of your options and choose the most cost-effective medicare solutions for your specific situation. If you need physical therapy, you may want to consider the medicare 8-minute rule when considering your options. 

What is Medicare Insurance, and How does it work?

The Medicare insurance plan, provided by the federal government, provides comprehensive health coverage. It is intended for persons who have reached the age of 65 or older, are planning their retirement, or are looking for a Medicare program for a family member who has reached that age.

On the other hand, Medicare only covers around 80% of all healthcare treatments, with no additional benefits such as hearing or vision examinations or dental treatment. Therefore, it is vital to shop around for cheap medicare options that fit your healthcare demands and your personal preferences.

What is the medicare 8-minute rule?

Many facilities that submit Medicare claims on a regular basis are well aware of the 8-minute restriction. But, for those unfamiliar with Medicare’s 8-minute limit, we’ve put together this piece just for you, which will guide you in detail.¬†

According to the 8-minute rule cheat sheet, an 8-minute rule calculator, you can bill Medicare insurance for 22 minutes if the service provider delivered at least 8 minutes of direct therapy. As a result, this can only apply to CPT codes that are time-based. However, the 8-minute rule does not apply to every limited-time CPT code, nor does it apply in every circumstance. Several procedures must be completed for you to invoice that particular code.

Medicare 8-Minute Rule Chart

Consider how the 8-minute rule should be used appropriately in light of all that has been said thus far. The first step is to compile a list of all the time spent on timed treatments and therapies (such as ultrasound or attended e-stim). The amount of time spent on untimed codes such as multiple modalities or evaluations/re-evaluations should be excluded from this calculation. You should calculate the total number of delayed coding units you can bill by referring to the chart below (which was sourced from www.ngsmedicare.com).

Medicare 8-minute rule chart is are as following according to which one can be facilitated with 8-minute rule therapy:

 

Medicare 8-Minute Rule Chart

 

8 to 22 minutes 

1 unit

23 to 37 minutes

2 units

38 to 52 minutes

3 units

53 to 67 minutes

4 units

68 to 82 minutes

5 units

83 minutes

6 units

8-Minute Rule Examples

Some of the more common 8-minute rule examples are going to discuss below:

  • If you perform a 35-minute first evaluation followed by a 7-minute therapeutic activity, you can only charge one unit for the initial assessment.
  • Why isn’t it applicable here? Because the first evaluation is not a time-based charge code, a 7-minutes therapeutic efficacy did not exceed the 8-minute limit. The physician must spend a bit extra time with the people in order to correctly bill for the exercise therapy.

Choose the Right Medicare Program

During the yearly open registration period. You can choose from various affordable Medicare solutions that fit your needs. Your health and healthcare insurance both are important, so take time to determine your needs and learn about all of your possibilities before deciding on affordable medicare solutions that are most suited to your needs.