Insights

The 8 Minute Rule & Workers’ Comp

Most practices are familiar with Medicare’s “8 Minute Rule” for billing time-based CPT codes. While Medicare historically required compliance with the rule, most workers’ compensation regulations did not address it. Until now.

Twelve states have begun strictly enforcing the billing rules related to the use of timecodes in workers’ compensation, prompting insurance carriers, TPAs and self-insured employers to take a closer look at provider compliance with the rule.  These states are Alabama, Indiana, Kentucky, Maine, Michigan, Minnesota, Montana, North Dakota, Pennsylvania, South Dakota, and Texas.  MedRisk encourages its network providers to follow the billing rules in these states when billing timed codes.

While regulations in Alaska, Arizona, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Kansas, Maryland, Nebraska, North Carolina, Ohio, South Carolina, Tennessee, Virginia and Washington are more ambiguous, payers may eventually be taking a closer look in these states as well.

MedRisk is here to help our network providers comply with all pertinent legislation and regulation and hopefully, this information will give you a good start.

There are various methods used to apply the 8 minute rule and each state has guidelines on which method to use. To avoid unnecessary denials, make sure that all billing for timed codes follows the appropriate rules in your state and is supported by the clinical notes and/or flow sheet.  If the billing units for timed CPT codes don’t match the treatment described in the supporting material, your bills will likely be denied and returned. Also, remember that your billing for timed codes cannot include time spent treating for untimed codes.

If you have any questions about this or anything else, please contact MedRisk’s Provider Relations Department at 866-697-3707 or providerrelations@medrisknet.com

We’re restoring movement, empowering recovery, and driving progress in workers’ compensation.

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