Speak with a licensed Insurance Agent

TTY Users 711

Mon - Fri, 8AM - 7PM CST

Medicare’s 8-minute rule applies to outpatient, in-person services

Medicare and the 8-Minute Rule

Have you heard of the 8-minute Rule? This term can confuse Medicare beneficiaries, and we’re here to explain what it is and how it works.

It’s helpful for beneficiaries to understand how practitioners charge Medicare for the services you receive. Physical therapists and other providers bill Medicare for the services they perform. Billing and claims methods include the use of Current Procedural Terminology (CPT) codes and rules. The 8-minute Rule, which Medicare requires, is one of these regulations.   

What is the Medicare 8-Minute Rule?

The Rule is an arrangement that pertains to time-based CPT codes for outpatient services, like physical therapy. It was made known in December 1999 and took effect on April 1, 2000. 

Medicare’s 8-minute Rule lets practitioners bill Medicare for one unit of service — if the length is a minimum of eight (but less than 22) minutes. A billable unit of service alludes to the time interval. The units of service contain 15 minutes each. The chart below outlines it:

Medicare’s 8-Minute Rule

Time Spent *# Of Billable Units
8 – 22 minutes1 unit 
23 – 37 minutes2 units
38 – 52 minutes3 units
53 – 67 minutes4 units
68 – 82 minutes5 units
83 – 97 minutes6 units
98 – 112 minutes7 units
113 – 127 minutes8 units

* Total time spent performing Time-Based CPT codes 

How Does it Work?

The Rule only applies to services where the specialist has direct contact with the patient. So, the service can’t be virtual; it must be in-person. If you’ve received multiple services, Medicare will be billed according to the total timed minutes per regimen. Medicare won’t be billed if a single service takes less than eight minutes. 

The services are billed in 15-minute units. So, if the service(s) take(s) 20 minutes, Medicare will get billed for one unit since the minutes fall between eight and 22. The pattern continues in 15-minute intervals past two-hour services. See the chart above. 

Related Post: 4 Things People New to Medicare Should Know

Who Follows the 8-Minute Rule?

These outpatient providers follow the Rule when they bill Medicare for their services:

  • Private practices
  • Rehabilitation facilities 
  • Skilled nursing facilities
  • Hospital outpatient departments — including emergency
  • Home health agencies providing therapy — covered under Part B in the beneficiary’s home 

The common features are that the services provided are in-person and outpatient.

An Example

Stanley goes to his physical therapist’s private practice. His PT spends 15 minutes evaluating his situation, 22 minutes on manual therapy, and six minutes answering Stanley’s questions. This visit takes a total of 43 minutes so that the office will bill Medicare for three units of service.   

Related Post: Filing a Medicare Complaint or Appeal

Why Is the 8-Minute Rule Important?

Sometimes providers aren’t aware of the complete range of services they need to bill, like assessments. This unawareness causes underbilling. Thus, patients should understand what Medicare can and should be billed for — so they know they’re not being overcharged. We hope this info helps clarify any confusion about the 8-minute Rule. 
For all your Medicare-related questions, give us a call at (855) 952-1941.