Therapy Practice Management Software with the Understanding of 8-Minute Rule Therapy Billing

Therapy Practice Management Software

For my 18 years in Medical Practice Industry, I know how critical it is to choose your best therapy practice management software. Most of my clients would ask me if I can recommend to them one particular therapy practice management software that they can use in their practice either it is cloud-based or having their own server in the office. Quite honestly, it is more important for you to understand how to properly and ethically bill for therapy services. And it is really important that the therapists understand the simple 8-Minute Rule for therapy billing purposes. No matter how great your therapy practice management software is, it is still up to the therapy billing strategies you can measure success and run a profitably therapy office. I always advise my clients that everything you render is always based on Medical Necessity and you must (imperative) document your services in a timely manner – real time I must say. So one of the important features of an excellent therapy practice management software is having a user-friendly, compliant and complete EMR Documentation feature integrated into the software. You don’t want headache and much more you don’t want to learn a lot more of things (the not-so computer savvy will have a problem unfortunately).

So let’s focus on this post on understanding the 8 minute rule for therapy billing. When you understand this concept, you will be excited how to find the best therapy practice management software. Believe me, a lot of Therapy Billing Offices and Therapists themselves doesn’t fully understand the 8 minute rule. This is a very simple rule. Are you ready?

Searched Key Phrase: Therapy Practice Management Software

Let me show you how the 8 Minute Rule for Physical Therapy Billing Works based on Medicare’s Guidelines:

Practice Management TherapistsThe 8 Minute Rule Physical Therapy Billing for Practice Management Therapists. Let’s try to understand this 8-minute rule.

Looking at our codes first; do you know what are your modalities? (there are a variety of therapy billing modalities that can help strengthen, relax, and heal muscles for patients requiring therapy billing services – may include electrical energy, thermal, light or mechanical agents/supplies/equipments)

There are 2 types of Modalities, the Constant Attendance Modality and the Supervised 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 billing 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

THERAPEUTIC PROCEDURES: (time-based! one or more areas, each 15 minutes) -Watch the 8 Minute Rule for Physical Therapy Billing

CPT Code 97110 – Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
CPT Code 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
CPT Code 97116 – Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)
CPT Code 97124 – Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression,percussion)
CPT Code 97139 – Unlisted therapeutic procedure (specify)
CPT Code 97140 – Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes
CPT Code 97530 – Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes

**CPT Code 97140 and CPT Code 97530 are bundled, if it supports medical necessity, you can append Modifier 59 on CPT 97530 to bypass the edit.

Practice Management Therapists here’s your CMS “8” – Minute Rule


therapy Practice Management SoftwareThe 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

Another Example:

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:

“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 – Practice Management Therapists Billing

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 – Practice Management Therapists Billing

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 Practice Management Therapists Billing

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 Practice Management Therapists Billing

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 Practice Management Therapists Billing

7 minutes of neuromuscular reeducation (97112)
7 minutes therapeutic exercise (97110)
7 minutes manual therapy (97140)
21 Total timed minutes

Searched Keyphrase: Therapy Practice Management Software

Wrapping Up!

As long as you understand how Therapy Billing works, its more easier for you to judge what Therapy Practice Management Software is best for your practice.

READ MORE: 11 Part B Therapy Billing Scenarios for PTs and OTs (from CMS Website)

Understand the Modifier 59 (updated as of 2015) before you decide on what to choose on Therapy Practice Management Software Therapy Billing.

Medicare Claims Processing Manual-Rev 3028 08-15-14 Chapter 5 Part B Outpatient Rehab clm104c05 – (for all your questions on functional limitations, 8 minute rule therapy billing, Coding CPT Codes for Physical Therapy, Occupational Therapy and SLP Services)

Chapter 12 – Comprehensive Outpatient Rehabilitation Facility (CORF) Coverage

Read the OIG (Office of the Inspector General) Report ~ “QUESTIONABLE BILLING FOR MEDICARE OUTPATIENT THERAPY SERVICES” (December 2010 OEI-04-09-00540) – very vital for those who are involved in therapy billing and choosing the right  Therapy Practice Management Software.




Therapy Practice Management Software

Ms. Pinky Maniri – Your Partner to Grow a Successful Medical Practice


Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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