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 orange 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.
