When it comes to coding and billing guidelines for Medicare, the instructions are quite specific. From service-based billing codes to time-based billing codes — and the anticipated Medicare 8-Minute Rule — proper documentation is crucial to receive payment for direct treatment. Unfortunately, most practice management software does not account for the intricacies surrounding rehab therapy billing, including thorough documentation of time-based treatment and time spent assessing a patient.
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Today, we’re sharing our top tips to avoid Medicare 8-Minute Rule mistakes and receive proper compensation for completed services.
But first…
What is the Medicare 8-minute rule?
The 8-minute rule was introduced in the year 2000 and is utilized by outpatient services, allowing a practitioner to bill for services as long as they see their patient for at least eight minutes. When billing for physical therapy, Medicare only allows services to be billed in 15-minute increments, but with the 8-minute rule, a physical therapist can bill for a 15-minute unit, even if they only saw the patient for eight minutes.
Using Service-Based vs. Time-Based Billing Codes
Medical billing codes are used to report therapeutic, surgical, and diagnostic procedures and services. In rehab therapy, we use these codes to bill physicians, private health insurance companies, and federal health insurance companies, such as Medicare, for our services. Across physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP), there are two types of billing codes we can use: service-based and time-based.
What are Service-Based Codes?
Service-based (or untimed) codes indicate a physical therapy or outpatient procedure has been provided, and bill for services such as:
- Physical therapy evaluation — 97161, 97162, or 97163
- Patient re-evaluation — 97164
- Hot/cold packs — 97010
After delivering service-based treatment, therapists can only bill for one code, regardless of how long was spent providing treatment.
What are Time-Based Codes?
Time-based codes are a bit different. Also known as “constant attendance” codes, time-based codes are billed in 15-minute increments. So, a provider is compensated for the direct amount of time spent delivering the service.
We use a time-based code to bill for services such as:
- Therapeutic exercise — 97110
- Manual therapy — 97140
- Ultrasound — 97035
Why the Medicare 8-Minute Rule is Crucial for Billing
Unlike a service-based code, a time-based code relies on the actual time spent with a patient. This caveat is especially important when billing Medicare. For time-based codes, providers must issue direct treatment for at least eight minutes to receive reimbursement.
When calculating the number of billable units for a patient, Medicare adds the total minutes of dedicated, one-on-one therapy, and divides the sum by 15. If eight or more minutes are leftover, providers can bill for one more unit. However, if seven or fewer minutes remain, we cannot bill an additional unit.
Imagine if we provided 54 minutes of various rehab therapy. Medicare would divide 54 by 15, and quantify that time as three whole units with nine remaining minutes. Because more than eight minutes remain, we can bill Medicare an additional unit.
If we had provided 51 minutes of therapy, Medicare would quantify that time as three whole units and six remaining minutes. Therefore, we could only bill for three time-based codes.
Can Assessment and Management Time Apply Toward the 8-Minute Rule?
One of the most common trends we see in rehab therapy billing is the omission of assessment and management time. However, billing codes are meant to report all therapeutic and diagnostic procedures and services, which include but aren’t limited to:
- Assessing the patient prior to performing a service
- Answering patient and/or caregiver questions
- Instructing the patient on-at-home self-care
- Documenting treatment throughout an appointment
Assessment and management are essential components of the patient plan of care (POC) and deserve to be included in our services rendered. We must accurately document all processes to ensure they are defensible if you plan to apply this time toward the Medicare 8-Minute Rule. In other words, documentation should be detailed, accurately describe the service, defend the clinical reasoning behind the treatment, and be easily understood by another provider.
When a therapist can confidently describe and defend the minutes spent assessing and managing a patient, Medicare may green-light the extra minutes — resulting in more complete, billable units.
Billing Medicare is one of the more intricate tasks in rehab therapy.
Learn how Net Health Therapy for Hospital Outpatient Clinics, Acute Care, and Private Practice can help improve thorough documentation for service-based and time-based billing codes, so teams can receive proper compensation for direct treatment.