8-Minute Rule vs. the Rule of 8s
The Medicare 8-Minute Rule and the Rule of 8s are two methods of calculating the number of allowed units for timed codes. When treating and billing for Medicare patients, you must bill in accordance with the Medicare 8-Minute Rule. This rule is automatically applied and cannot be changed. The Rule of 8s is our label for the minute rule published in the CPT code manual. It is an optional setting that can be applied to non-Medicare insurance types.
Remember: These rules are only applied to Direct-Timed Codes.
8-Minute Rule
The Medicare 8-Minute rule calculation looks at the total minutes and units for Timed Codes.
- 1 unit = at least 8 minutes of a service are needed
- 2 units = at least 23 minutes of a service are needed
It doesn't matter if there are 2 units of the same service (97110) OR 1 unit each of two different services (97110 and 97116); the rule always applies.
Click here to read more about the Medicare 8-Minute Rule.
Rule of 8s
The Rule of 8’s follows the same principles of the Medicare 8-Minute Rule; however, it is calculated on a per-service basis. Specifically, you must perform half the service time described in a timed code before you can bill 1 unit of that code. The timed codes therapists use typically have 15 minutes in the definition, so at least 8 minutes of a unique service must be performed to bill one unit of that service.
Note: this rule only applies to relevant timed codes that have 15 minutes as the "usual time" in the operational definition of the code. It’s important to note that this rule should only be applied if your payer contract supports it.
The Rule of 8s is applied to each timed service separately, so the math is also applied separately:
1 unit of a unique service = at least 8 minutes of a service are needed for each unique service billed
- 10 minutes of 97110 in a single visit = 1 unit
- 10 minutes of 97110 AND 10 minutes of 97116 in a single visit = 2 units total [1 unit of 97110 and 1 unit of 97116 because I have the minimum 8 minutes for each service]
2 units of a unique service = at least 23 minutes for that unique service
- 25 minutes of 97110 in a single visit = 2 units
- 25 minutes of 97110 AND 10 minutes of 97116 in a single visit = 3 units total [2 units of 97110 because I have the minimum of 23 minutes and 1 unit of 97116 because I have the minimum of 8 minutes]
Primary and Secondary Insurance Rules
In the Company Settings, you can choose to always defer to the Primary Payer or always defer to the 8-minute Rule. This allows you to determine how your organization wants to handle situations where the primary and secondary payers follow conflicting rules.