Wiki 8 Minute Rule Clarification - Rolling Minutes

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VeronicaCCBC

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I work in a Massachusetts Certified Behavioral Health Clinic, where we bill the H2011 code for psychiatric crisis follow-up services. This code is billed in 15-minute timed units. Currently, each encounter must reach the 8-minute minimum, and then the total minutes from each encounter are added up to use the 8-minute rule to determine the number of units.

However, I am debating with my EHR (which is integrating a billing function) whether this is the correct way to calculate units. Their view is that all minutes from each encounter within the same calendar day should accumulate and then follow the 8-minute rule. This means if a client is seen by three separate providers (within the same agency), all minutes added up could meet the 8-minute minimum.

Does anyone have any guidance on this? We are allowed to bill multiple units in a day, but I do not believe that three separate services totaling 8 minutes equate to a billable unit. Any help is appreciated.
 
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Veronica
In order to bill H2011 must do 15 minutes of treatment not 8 minutes. Each provider can bill H2011 with up to 15 minutes..You cannot break it 8 minute with one provider and next 7 minutes wiht another. Each therapist need to document care for up to 15 minutes or more. You can have 3 differ provider for one date of service with H2011. Most EHR can set units up for certain amount time 15 minute is standard unit for this code IN ORDER to BIll. If not treated over 15 minutes cannot bill. Also each therapist stats for care given on that day needs to be counted.
I hope this data helps you
Lady T
 
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Thank you for your response, but can you further clarify? My understanding is that the 15 minute timed unit must reach a minimum of 8 minutes and a maximum of 22 minutes, to bill one unit. Further that if 23-37 minutes are spent on the service that we would bill 2 units.
 
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VeronicaCCBC said:
Thank you for your response, but can you further clarify? My understanding is that the 15 minute timed unit must reach a minimum of 8 minutes and a maximum of 22 minutes, to bill one unit. Further that if 23-37 minutes are spent on the service that we would bill 2 units.
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Ahh no it should reach 15 minutes to bill not 8 minutes. This is guide for HCPCS manual for H2011.The behavioral health assessments state bill atleast 16 minutes CPT codes of 96158, 96164 ,96167, 96170 96167 . If these are less than 16 minutes DO NOT bill. See pg 862 in CPT manual year 2025. However if the commercial payer wants this billed in 8 minutes guess it is ok but that is not the norm
Hope helped you
Lady T
 
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