Let me show you how the 8 Minute Rule for Physical Therapy Billing Works based on Medicare's Guidelines:
The 8 Minute Rule for Physical Therapy Billing
Let's look at our codes first;
Do you know what are your modalities? (there are a variety of therapy modalities that can help strengthen, relax, and heal muscles for patients requiring therapy services - may include electrical energy, thermal, light or mechanical agents/supplies/equipments)
There are 2 types of Modalities, the Constant Attendance Modality and theSupervised Modality.
1. Constant Attendance Modality (billed in 15 minutes increments) - REQUIRES direct one-on- one provider to patient contact.
97032 - Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes 97033 - Application of a modality to 1 or more areas; iontophoresis, each 15 minutes 97035 - Application of a modality to 1 or more areas; ultrasound, each 15 minutes 97039 - Unlisted modality (specify type and time if constant attendance)
2. Supervised Modality (billed one unit per date of service, regardless of number of anatomical body areas)
DO NOT REQUIRE direct one-on-one provider to patient contact.
97010 - Application of a modality to 1 or more areas; hot or cold packs 97012 - Application of a modality to 1 or more areas; traction, mechanical 97014 - Application of a modality to 1 or more areas; electrical stimulation (unattended)
***** CMS code G0283 - Electrical stimulation (unattended), to one or more areas for indication (s) other than wound care, as part of a therapy plan of care
97024 - Application of a modality to 1 or more areas; diathermy (eg, microwave) 97026 - Application of a modality to 1 or more areas; infrared 97028 - Application of a modality to 1 or more areas; ultraviolet
Here are your THERAPEUTIC PROCEDURES: (time-based! one or more areas, each 15 minutes) -Watch the 8 Minute Rule for Physical Therapy Billing
97110 - Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112 - Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 97116 - Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) 97124 - Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 97139 - Unlisted therapeutic procedure (specify) 97140 - Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 97530 - Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes
** 97140 and 97530 are bundled, if it supports medical necessity, you can append Modifier 59 on CPT 97530 to bypass the edit.
CMS "8" - Minute Rule
The 8 Minute Rule for Physical Therapy Billing
1 unit ≥ 8 minutes through 22 minutes 2 units ≥ 23 minutes through 37 minutes 3 units ≥ 38 minutes through 52 minutes 4 units ≥ 53 minutes through 67 minutes 5 units ≥ 68 minutes through 82 minutes 6 units ≥ 83 minutes through 97 minutes 7 units ≥ 98 minutes through 112 minutes 8 units ≥ 113 minutes through 127 minutes
*** less than 8 minutes is not billable if only one time-based code is used on thesame date of service or on the same day *** for one time-based code performed in 15 minutes must be billed as 1 unit from looking at the rule (8-22 minutes equals 1 unit!)
Let's do the Math:
->Get the total minutes for all time-based therapy codes:
97110 for 32 minutes 97140 for 12 minutes == TOTAL MINUTES is 44 minutes (go back to the chart, 44 minutes is 3 units!)
BILL 97110 for 2 units and 97140 for 1 unit
97124 for 10 minutes 97110 for 16 minutes 97140 for 29 minutes == TOTAL MINUTES is 55 minutes (go back to the chart, 55 minutes is 4 units!)
BILL 97140 for 2 units 97110 for 1 unit and 97124 for 1 unit
Look at these examples as given by CMS: Pub 100-04 MCR Claims Processing Transmittal 2121 CR 7247 12-17-2010 R2121CP
Pub. 100-02, chapter 15, section 230.3B
"Treatment Notes indicates that the amount of time for each specific intervention/modality provided to the patient is not required to be documented in the Treatment Note. However, the total number of timed minutes must be documented. These examples indicate how to count the appropriate number of units for the total therapy minutes provided."
Example 1 - 24 minutes of neuromuscular reeducation, code 97112, 23 minutes of therapeutic exercise, code 97110, Total timed code treatment time was 47 minutes.
See the chart above. The 47 minutes falls within the range for 3 units = 38 to 52 minutes.
Appropriate billing for 47 minutes is only 3 timed units. Each of the codes is performed for more than 15 minutes, so each shall be billed for at least 1 unit. The correct coding is 2 units of code 97112 and one unit of code 97110, assigning more timed units to the service that took the most time.
Example 2 - 20 minutes of neuromuscular reeducation (97112) 20 minutes therapeutic exercise (97110), 40 Total timed code minutes.
Appropriate billing for 40 minutes is 3 units. Each service was done at least 15 minutes and should be billed for at least one unit, but the total allows 3 units. Since the time for each service is the same, choose either code for 2 units and bill the other for 1 unit. Do not bill 3 units for either one of the codes.
Example 3 33 minutes of therapeutic exercise (97110), 7 minutes of manual therapy (97140), 40 Total timed minutes
Appropriate billing for 40 minutes is for 3 units. Bill 2 units of 97110 and 1 unit of 97140. Count the first 30 minutes of 97110 as two full units. Compare the remaining time for 97110 (33-30 = 3 minutes) to the time spent on 97140 (7 minutes) and bill the larger, which is 97140.
Example 4 18 minutes of therapeutic exercise (97110), 13 minutes of manual therapy (97140), 10 minutes of gait training (97116), 8 minutes of ultrasound (97035), 49 Total timed minutes
Appropriate billing is for 3 units. Bill the procedures you spent the most time providing. Bill 1 unit each of 97110, 97116, and 97140. You are unable to bill for the ultrasound because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless of how many services were performed). You would still document the ultrasound in the treatment notes.
Example 5 7 minutes of neuromuscular reeducation (97112) 7 minutes therapeutic exercise (97110) 7 minutes manual therapy (97140) 21 Total timed minutes
Appropriate billing is for one unit. The qualified professional ( See definition in Pub 100-02/15, sec. 220) shall select one appropriate CPT code (97112, 97110, 97140) to bill since each unit was performed for the same amount of time and only one unit is allowed.
READ MORE: 11 Part B Billing Scenarios for PTs and OTs (from CMS Website)
See # 220 - Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance See # 230 - Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology
Read the OIG (Office of the Inspector General) Report ~ "QUESTIONABLE BILLING FOR MEDICARE OUTPATIENT THERAPY SERVICES" (December 2010 OEI-04-09-00540)
COMPLIANCE IS A MUST IN ANY MEDICAL PRACTICE. ETHICS PLAYS A VITAL ROLE. EDUCATION & PROPER KNOWLEDGE OF YOUR OFFICE STAFF IS VERY IMPORTANT.