![]() ![]() Now, a good EMR ( like WebPT) will provide you with plenty of help and alerts to ensure that you’re billing appropriately and in compliance with the 8-Minute Rule. Calculate the total units justified by time calculate the full 15-minute units and if time justifies additional units, compare the minutes of the partial units remaining and bill the larger.” Thus, the correct billing would be two units of EX, two units of NM, one unit of MT, one unit of TA, and one unit of ESUN.Īccording to Ambury: “The key to the 8-Minute Rule is to do the math. In this example, you’d add one unit of TA (13 minutes) and one unit of NM (ten minutes). This justifies two additional units, but which two? To determine this, compare the time left over from the incomplete units and then bill the two largest of the units remaining. In this example, there are two full 15-minute units of EX, one full 15-minute unit of NM with ten minutes left over, and one full 15-minute unit of MT with two minutes left over-all of which support four units of charge.īut what to do about those leftover minutes? As a reminder, we have 13 minutes of TA, ten minutes of NM, eight minutes of US, and two minutes of MT remaining. For the distribution portion you must determine how many full 15-minute units you performed. The 15 minutes of ESUN supports an additional supervised billing unit for a total of seven units. To correctly calculate the charge, you would add the constant attendance procedures and modalities:ģ0 min + 25 min + 17 min + 13 min + 8 min = 93 direct timed minutes, which support six billing units. On a single date of service, you perform 30 minutes of therapeutic exercise (EX), 25 minutes of neuromuscular (NM), 17 minutes of manual therapy (MT), 13 minutes of therapeutic activity (TA), eight minutes of ultrasound (US), and 15 minutes of electrical stimulation unattended (ESUN). Thus, the correct billing would be two units of EX, one unit of MT, one unit of US, and one unit of ESUN. The eight minutes of ultrasound is the remaining charge. In this example, there are two full 15-minute units of EX and one full 15-minute unit of MT, so that‘s three units out of four. The 15 minutes of ESUN supports an additional supervised billing unit for a total of five units. To correctly calculate the charge, you would add the constant attendance procedures and modalities:ģ0 min + 15 min + 8 min = 53 direct timed minutes, which support four billing units. On a single date of service, you perform 30 minutes of therapeutic exercise (EX), 15 minutes of manual therapy (MT), eight minutes of ultrasound (US), and 15 minutes of electrical stimulation unattended (ESUN). According to Ambury, this is what determines how many-and which-units you can bill. (Note that there’s a cumulative and distribution portion of these calculations). If you perform multiple time-based or constant attendance services, you must calculate the total number of direct timed minutes as well as the total treatment time. Simple, right? Well, here’s where it can get a little complicated. Per the 8-Minute Rule, you’d need to perform therapeutic exercise for eight minutes in order to bill. You cannot bill for therapeutic exercise because you performed this procedure for seven minutes. If you perform an initial evaluation for 35 minutes and therapeutic exercise for seven, you would charge one unit of physical therapy evaluation. ![]() Here’s an example from compliance expert Tom Ambury: Example #1 Here’s where the 8-Minute Rule comes in: according to this article, in order to receive reimbursement from Medicare for a time-based code, you must provide direct treatment for at least eight minutes. Time-based (or constant attendance) codes, on the other hand, allow for variable billing in 15-minute increments when a practitioner provides a patient with one-on-one services, such as therapeutic exercise, manual therapy, neuromuscular re-education, therapeutic activities, gait training, ultrasound, iontophoresis, and electrical stimulation. For these types of services, it doesn’t matter if you complete the treatment in 15 minutes or 45, because you can only bill for one code. Service-based (or untimed) codes are those that you’d use for things like conducting a physical therapy evaluation or re-evaluation, applying hot/cold packs, or performing electrical stimulation (unattended). There are two types of CPT codes you’ll need to understand in order to bill properly: service- and time-based. In honor of this month’s compliance theme, here’s everything you need to know about how therapists determine what to bill to Medicare for outpatient therapy services (a.k.a. ![]()
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