Does TRICARE Follow Medicare’s “8-Minute Rule”?

June 6, 2022
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) implemented what providers of outpatient therapy call “Medicare’s 8-minute rule” in 2000. There is a misconception that the “8-minute rule” applies automatically to all federal insurance carriers and Medicare Advantage plans. That is actually not true. Each federal insurance carrier and Medicare Advantage plan can determine if they want to apply Medicare’s “8-minute rule” for payment for outpatient therapy services or use the American Medical Associations’ (AMA) substantial portion methodology.

In this article, I will provide the answer to TRICARE and do they follow Medicare’s “8-minute rule” or the AMA substantial portion methodology.

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  1. Does Medicaid MCO’s (West Virginia) follow the 8 minute rule? and Do they require signed Plan of Cares?

    Thank You.