• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki 8 MINUTE RULE FOR PHYSICAL THERAPY BILLING

Create Wiki
D

davisday

New
Messages
6
Location
Mineral Ridge, OH
Best answers
0
HAS ANYONE HEARD OF THIS BILLING OF UNITS. I WAS ALWAYS TAUGHT YOU CAN ONLY BILL UP TO THE TOTAL TIME SERVICES RENDERED. THIS ARTICLE IS STATING YOU COULD BILL UP TO 4 UNITS IN 32 MINUTES WHICH I TAKE THAT AS ONLY BEING ABLE TO BILL 2 UNITS BASED ON TOTAL TIME. PLEASE ANY INSIGHT TO THIS AS CORPORATE IS TELLING ME WE CAN DO THIS.
 

Attachments

Some time based codes have a mid-point rule, where you can bill a full unit if the midpoint is exceeded. So for a 15 minute session, only 8 minutes has to be exceeded to bill one unit. This is common for Physical Therapy.
Be careful, though. Not all time based services allow billing according to the midpoint rule, and those that do often have charts to illustrate how to calculate time. Prolonged services, for example, specifically states in the instructional notes that you can bill only for the full 15 minutes.
I strongly disagree with the above, if the 32 minutes is for the same patient. 32 minutes on the same patient would be 2 units. 8 minutes for four patients would allow you to bill 4 patients at a unit each. Your link actually explains that you have to divide 15" into the total time; if more than 8 minutes is the remainder, then you could bill an additional unit. I do not see in your article where it explicitly says you can bill 4 units for 32 minutes of time. Can you point that out to me? At any rate, "Corporate" is incorrect in your example above.
 
I am trying to create a spreadsheet for our physicians on which insurances follow 8 minute vs ama guidelines. I am getting conflicting results from the 2025 updates on UHC commercial and Cigna commercial. I currently have that UHC follows the 8 minute rule with 4 unit max; however the wording on UHC commercial policy updated in 2025 uses terminology (max combined frequency/8 minutes of therapy service must be performed to meet the minimum time qualification of 15 minutes) that could go either way. For Cigna I'm finding they follow AMA guidelines with a 4 unit max. Any insight would be appreciated for UHC and Cigna?
 
You must log in or register to reply here.
Top