The 8-minute rule can be applied only to services where the specialist has direct contact with the Medicare beneficiary.
If have received one or more services, specialists will bill Medicare according to the total time minutes per provided service. Therefore, if beneficiaries provided services do not last at least eight minutes, Medicare can’t be billed for it.
When it comes to Medicare, intervals are divided into 15-minute units. For example, if provided services lasted for 22 minutes, Medicare will be billed for 1 united because the interval counted is between 8 to 22 minutes. As told, each interval of billable units lasts 15 minutes. That is only valid for time-based CPT code procedures, not for service-based CPT code procedures.
Time Spent on Time-Based Codes vs. Number Of Billable Units
Let’s break this down to make 8-minute rule billing more understandable. Time spent on services and billable units works like this:
- 8-22 minutes = 1 billable unit
- 23-37 minutes = 2 billable units
- 38-52 minutes = 3 billable units
- 53-67 minutes = 4 billable units
- 68-82 minutes = 5 billable units
- 83-97 minutes = 6 billable units
- 98-112 minutes= 7 billable units
- 113-127 minutes = 8 billable units
This rule only applies to time-based outpatient services, according to CPT codes, and allows specialists to bill Medicare according to the 8-minute rule above for provided services.
Minutes vs. Billing Units
According to CPT requirements, each time equals 15 minutes of service. However, the time for this code and time of the treatment will not always be divided into 15-minutes intervals as portrayed on the chart above. There are examples when practitioners can provide service-based procedures in combination with time-based procedures. For example, they performed ultrasound for 8 minutes and manual therapy for 11 minutes. Per Medicare rules, practitioners must provide services for at least 8 minutes to bill one unit of a timed CPT code.
Therefore, Medicare adds up the total minutes of direct therapy (face-to-face) and divides it into 15 minutes intervals which equals one billing unit. In other words, practitioners bill can only bill Medicare for an additional unit if there are 8 or more minutes left. But if the time that is left is seven or fewer minutes, Medicare can’t reimburse practitioners for another full unit no matter if service is provided.
How To Calculate Billing Units
Practitioners can calculate billing units based on Medicare’s 8- minute rule by following these easy steps:
- Connect all the time spent on providing timed services to see how many units you can bill overall
- Separate out each whole 15-minute unit by CPT codes to see which are service-based and which are time-based procedures by CPT codes ( because service-based procures are always one billable unit)
- If there are any left minutes that have not been converted into units, these are practitioners’ “mixed remainders.” Medicare allows providers of services to mix different services for the remaining minutes. This helps practitioners create whole units and bill accordingly if there are enough remainder minutes
- If there are still 8 remaining minutes left of service, the bill is for another unit interval
If there are any questions about outpatient services and how Medicare is billed according to the 8-minute rule, call Better Place Insurance Group. We are eager to help you!