The 8 Minute Rule On Billing Timed Services!
Does the CPT rule require 15 minutes or 8?
The 8 minute rule on CPT coding!
A. The 8 minute rule for “timed” codes:
There are (1) service-based codes and (2) time-based codes. The CPT codebook guidelines defines “a unit of time” as “attained when the mid-point is passed.” So the mid-point for 15 minutes would be 7.5 minutes and “passed” the mid-point would be 8 minutes. So you don’t need to provide 15 minutes of treatment just because the definition states 15 minutes. If a doctor performs 8 minutes of a 15 minute procedure then the doctor can bill one unit.
**All of the examples in this blog use a 15 minute timed CPT code.
B. What if two “timed” codes are billed in the same visit?
The 8 minute rule was created to avoid abuse by insurance companies who might complain that only 14 minutes of a 15 minute procedure was provided (and therefore not payable). Because some doctors could abuse the 8 minute rule by providing two timed codes in single visit there is another rule. If there are multiple “timed” codes performed in one visit then the doctor would have to add up the total number of minutes and use the published “range of minutes” listed below.
This is the range of minutes:
- 0-7 minutes= 0 units (unless you bill -52 modifier–see below)
- 8-22 minutes= 1 unit
- 23-37 minutes= 2 units
- 38-52 minutes= 3 units
- 53-67 minutes= 4 units
EXAMPLE ONE- A provider performed 8 minutes of unattended electric stim and 8 minutes of massage (totals 16 minutes). The doctor could only bill for one of those units (but should also document that both procedures were performed).
EXAMPLE TWO– A provider performed 23 minutes of unattended electric stim and 7 minutes of massage (totals 30 minutes). The provider should bill one unit of electric stim and one unit of massage.
C. Treatment for 7 minutes or less:
Modifier 52 indicates a reduced service. If the “mid-point” is not passed then the doctor should use a -52 modifier and notate their records why the mid-point was not passed.
EXAMPLE THREE– A provider performed 7 minutes of unattended electric stim. That provider should bill modifier 52 to indicate a reduced service.
-If there are other timed codes then you would add the 7 minutes to the other timed codes per the “range” listed above.
EXAMPLE FOUR– A provider performed 16 minutes of unattended electric stim and 7 minutes of massage (totals 23 minutes). The provider should bill one unit of electric stim and one unit of massage.