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 explain Medicare’s “8-minute rule”, who it applies to (Medicare Advantage plans and state Medicaid programs?) and also explain how to bill non-Medicare insurance carriers who do not follow the “8-minute rule” when providing time-based interventions and procedures.
Lets begin with the “8-minute rule”! The Centers for Medicare and Medicaid Services (CMS) implemented the ‘8-minute rule” in calendar year 2000. The “8-minute rule” only applies to those CPT codes
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