Who Follows the 8-Minute Rule for Therapy

October 17, 2016
Rick Gawenda

One of the most common questions I receive, either via email or at my live seminars, is “What insurance carriers follow the 8-minute rule for outpatient therapy? Well, we all know the Medicare program follows the 8-minute rule for outpatient therapy services. This is true for all outpatient therapy services provided to Medicare beneficiaries in the following settings:

  • Private Practice
  • Skilled Nursing Facilities
  • Comprehensive Outpatient Rehabilitation Facilities
  • Rehabilitation Agencies
  • Home Health Agencies providing Part B therapy in the beneficiaries home
  • Hospital Outpatient Departments
  • Medicare patient’s seen for therapy while they are in the emergency department or under observation status in a hospital setting and do not get admitted

But did you know the 8-minute rule also applies to other insurance carriers besides traditional Medicare? The 8-minute rule applies to all insurance carriers who

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  1. BCBS Federal had never occurred to me. So the Federal aspect supercedes the private carrier piece?

  2. So – “managed Medicare plans, managed Medicaid plans” – meaning Med Advantage plans and local MCO / medicaid plans? What else would fall under that category?

  3. Rick does he 8 Minute rule apply to Inpatient Acute Part A patients. If not is there a reference that supports that the rule does not apply to part A?

    1. The “8-minute rule” applies to Medicare Part B therapy services. Under Part A, you are not paid via the Medicare Physician Fee Schedule.

  4. Does the 8 minute rule apply to pediatric private practice settings, where most services are billed through Medicaid?

    1. You would have to check with your state Medicaid program to see if they have implemented the “8-minute rule”.

  5. A critical access hospital inpatient is reimbursed based on cost. Does the 8 minute rule apply to med B patients for inpatient therapies?