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06/06/22

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

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

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10/07/19

Billing Scenario’s for PT & OT: Part 1

This week, I will provide 3 billing scenario’s that can be applicable to either outpatient physical therapy or outpatient occupational therapy services and provide the billing answer for Medicare beneficiaries and those insurance carriers that follow the Medicare Program billing rules (i.e. “8-minute rule) and will also provide the billing answer for those insurance carriers that do not follow the Medicare Program billing rules, rather, follow the definition of a substantial portion of a time-based CPT per the American Medical Association (AMA). Two articles that you may want to read prior to continuing on with this article are “What CPT

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04/29/19

What is Substantial of a Time-Based CPT Code

For those of us that treat Medicare beneficiaries for outpatient physical, occupational and/or speech-language pathology services, we all understand that the Medicare program utilizes what as come to be known as the “8-minute rule” when determining how many time-based units can be billed during an outpatient therapy visit. But what about non-Medicare insurance carriers that do not utilize the “8-minute rule”? How do we determine how much time of a time-based CPT code must be provided in order to bill that CPT code to an insurance carrier that does not follow the Medicare “8-minute rule”? In this article, I will

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08/21/17

What CPT Codes Does The “8-Minute Rule” Apply To

A question I often receive is what CPT codes does the so called “8-minute rule” apply to? Does it apply to just the 15-minute time-based CPT codes or does it also apply to the 1-hour time-based CPT codes as well as the untimed, supervised modality CPT codes and untimed evaluation CPT codes? The “8-minute rule” applies to all CPT codes

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