Coding Rule Definitions

Created by Misty Ahmad, Modified on Mon, 23 Sep at 6:37 PM by Jen Sommers

Practice Intel:

There are two main coding rules that insurance companies expect therapists to follow when billing for timed rehab CPT codes. In PredictionHealth, you will see the rules referred to as Total Minute Rule and AMA Rule, but there are other names for them. You might see the Total Minute Rule also called the Medicare 8-min Rule. The AMA Rule can also be referred to as Substantial Portion Methodology (SPM) or Rule of 8s.

The decision to use the Total Minute Rule or AMA Rule is determined by your insurance contract. As a general rule, Medicare or other Federal Payers will follow the Total Minute Rule while commercial insurances typically follow the AMA Rule.

Total Time Rule

Code for the total time spent with the patient, where all of the minutes are totaled together in order to calculate the units.
- One unit = 8-22 min = You are allowed to bill a total of 1 units
- Two unit = 23-37 min = You are allowed to bill a total of 2 units
- Three units = 38-52 min = You are allowed to bill a total of 3 units
- Four units= 53-67 min = You are allowed to bill a total of 4 units
- Five units = 68-72 min = You are allowed to bill a total of 5 units

AMA Rule

Code units for the time spent during each CPT code instead of combining the total time spent with the patient to calculate units.
- One unit of the same CPT Code = 8-22 min
- This applies for each unique CPT code a therapist bills
- The most efficient way to charge would be to have as many codes as possible each at 8 min

Total Minute Rule vs. AMA Rule Examples

Scenario 1

Total Minute Rule	AMA Rule
10 min Therapeutic Activity	10 min Therapeutic Activity
8 min Manual Therapy	8 min Manual Therapy
18 min 1 Unit	18 min 2 Units

Under the Total Minute Rule, 18 min fits in the 8-22 min range so it is billed at 1 unit
Under AMA Rule, there are 2 different codes that fall within the 8-22 min range so you will charge 1 unit for each or 2 total units.

Scenario 2

Total Minute Rule	AMA Rule
6 min Therapeutic Activity	6 min Therapeutic Activity
6 min Therapeutic Exercise	6 min Therapeutic Exercise
6 min Manual Therapy	6 min Manual Therapy
18 min 1 Unit	18 min 0 Units

Under Total Minute Rule, 18 min fits in the 8-22 min range so it is billed at 1 unit
Using AMA Rule, the patient would not be charged since none of the CPT codes were greater or equal to 8 minutes
- Since no single unit is greater than or equal to 8 minutes 0 units will be charged

Scenario 3

Total Minute Rule	AMA Rule
10 min Therapeutic Exercise	10 min Therapeutic Exercise
10 min Manual Therapy	10 min Manual Therapy
10 min Neuro Re Education	10 min Neuro Re Education
30 min 2 units	30 min 3 units

Under Total Minute Rule, 30 min fits in the 23-37 min range so it is billed at 2 units
Under AMA Rule, there are 3 different codes that fall within the 8-22 min range so you will charge 1 unit for each

Scenario 4

Total Minute Rule	AMA Rule
30 min Therapeutic Activity	30 min Therapeutic Activity
4 min Therapeutic Exercise	4 min Therapeutic Exercise
7 min Manual Therapy	7 min Manual Therapy
41 min 3 units	41 min 2 units

Under Total Minute Rule, 41 min fits in the 38-52 min range so it is billed at 3 units
Under AMA Rule, there are 2 different codes that did not fall within the minimum 8-22 min range so you would not charge any units for those 2 codes. You would charge 2 units for the code containing 30 min

Scenario 5

Total Minute Rule	AMA Rule
25 min Therapeutic Activity	25 min Therapeutic Activity
10 min Manual Therapy	10 min Manual Therapy
35 min 2 units	35 min 3 units

Under Total Minute Rule, 35 min fits in the 23-37 min range so it is billed at 2 units
Under AMA Rule, there are 2 different codes one falls within the 23-38 min (2 units) range and the other in the 8-22 min (1 unit) range for a total of 3 charged units

Scenario 6

Total Minute Rule	AMA Rule
8 min Therapeutic Activity	8 min Therapeutic Activity
8 min Therapeutic Exercise	8 min Therapeutic Exercise
8 min Manual Therapy	8 min Manual Therapy
8 min Neuro Re Education	8 min Neuro Re Education
32 min 2 units	32 min 4 units

Under Total Minute Rule, 32 min fits in the 23-37 min range so it is billed at 2 units
Under AMA Rule, there are 4 different codes with all of them in the 8-22 min (1 unit) range for a total of 4 charged units