![]() Learn how to avoid common PT billing mistakes. If eight or more minutes are left over, you can bill for one more unit if seven or fewer minutes remain, you cannot bill an additional unit. ![]() Basically, when calculating the number of billable units for a particular date of service, Medicare adds up the total minutes of skilled, one-on-one therapy and divides that total by 15. electrical stimulation (manual) (97032)įor time-based codes, you must provide direct treatment for at least eight minutes in order to receive reimbursement from Medicare.You would use these codes for performing one-on-one services such as: Time-based (or constant attendance) codes, on the other hand, allow for variable billing in 15-minute increments. In such scenarios, you can only bill the code once, regardless of how long you spend providing treatment. electrical stimulation (unattended) (97014 or G0283 for Medicare).You would use a service-based (or untimed) code to bill for services such as: What are service-based CPT codes?Ī service-based CPT code denotes a one time therapy service provided to the patient that is independent of time. To correctly apply the 8-Minute Rule, you must first understand the difference between service-based CPT codes and time-based ones. With most buyer-seller transactions, calculating the cost of a product or service is fairly simple.The key feature of the 8-Minute Rule-and the origin of its namesake-is that to receive payment from Medicare for a time-based (or constant attendance) CPT code, a therapist must provide direct treatment for at least eight minutes. There are no complicated formulas for determining the monetary value of a pizza or a movie ticket you simply pay the business’s advertised price. When it comes to Medicare units and payment for physical therapy services, however, things aren’t always so simple. Yes, I’m talking about the dreaded 8-Minute Rule (a.k.a. ![]() So, here’s a rundown of the rule-and a short explanation of how it works in WebPT. The 8-Minute Rule governs the process by which rehab therapists determine how many units they should bill to Medicare for the outpatient therapy services they provide on a particular date of service. (This rule also applies to other insurances that have specified they follow Medicare billing guidelines.) Basically, a therapist must provide direct, one-on-one therapy for at least eight minutes to receive reimbursement for one unit of a time-based treatment code. It might sound simple enough, but things get a little hairy when you bill both time-based and service-based codes for a single patient visit. So first, let’s talk about the difference between time-based and service-based CPT codes. You would use a service-based (or untimed) code to denote services such as conducting a physical therapy examination or re-examination, applying hot or cold packs, or providing electrical stimulation (unattended). For services like these, you can’t bill more than one unit-regardless of the amount of time you spend delivering treatment. Time-based (or direct time) codes, on the other hand, allow you to bill multiple units in 15-minute increments (i.e., one unit = 15 minutes of direct therapy). These are the codes you use for one-on-one, constant attendance procedures and modalities such as therapeutic exercise or activities, manual therapy, neuromuscular re-education, gait training, ultrasound, iontophoresis, or electrical stimulation (attended). Minutes and Billing UnitsĪccording to CPT guidelines, each timed code represents 15 minutes of treatment. But your treatment time for these codes won’t always divide into perfect 15-minute blocks. What if you only provide ultrasound for 11 minutes? Or manual therapy for 6 minutes? That’s where the 8-Minute Rule comes in: Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes. In other words, Medicare adds up the total minutes of skilled, one-on-one therapy (direct time) and divides the resulting sum by 15. If eight or more minutes are left over, you can bill for an additional unit. But if seven or fewer minutes remain, Medicare will not reimburse you for another full unit, and you must essentially drop the remainder. ![]() To give a simple example, if you performed manual therapy for 15 minutes and ultrasound for 8 minutes, you could bill two direct time units. However, when untimed codes come into play, things get a little more confusing. Then, check your total against the chart below to see the maximum total number of codes you can bill: So, to figure out how many total billing units you have, you should always start by adding up your one-on-one time (leave unattended time out of the equation). ![]()
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