The 8 minute rule for Medicare requires therapists to provide a time-based treatment for at least 8 minutes before receiving reimbursement from Medicare.
The CMS guidelines actually describe a 15 minute unit rule instead of an 8 minute rule…we therapists just named it the 8-minute rule because that’s when reimbursement starts.
What is the 8 minute rule?
The 8 minute rule is a Medicare guideline for determining how many billable units may be charged in rehabilitation based on time spent with the patient. Billable units are based on 15 minute increments, once the initial 8 minutes have been met, which is how the name “8 minute rule” developed.
Think of 8 minutes as the tipping point, or the half way mark to the 15 minute block. Once you’ve crossed 8 minutes, the 15 minute block counts as a unit!
So why is it called the 8 minute rule?
Within a 15 minute block of time, you cross the half-way threshold at 8 minute… well, technically 7 minutes and 30 seconds.
So spending at least 8 minutes with someone means that you’ve ‘satisfied’ the majority of the 15 minute block of time in order to bill for one unit.
From the CMS website:
For any single timed CPT code in the same day measured in 15 minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes, then 2 units should be billed
Technically it’s the “8 Minutes Plus 15 Rule”….
Yes, as you can see in this handy chart, the total timed minutes you spend on timed treatment CPT codes determines how many units you can bill Medicare.
Good to Know: The total timed minutes of time-based CPT codes determines total billable units. So you might perform 3 different treatments, but only spend 5 minutes on each, so your total timed minutes is 15. As you can see, 15 minutes only equals 1 unit, so you’ll have to choose which CPT code to bill out.
8 Minute Rule Chart
|8 – 22 minutes||1 unit|
|23 – 37 minutes||2 units|
|38 – 52 minutes||3 units|
|53 – 67 minutes||4 units|
|68 – 82 minutes||5 units|
|83 minutes||6 units|
Timed vs Untimed Codes
Remember the 8 minute rule only counts for timed minutes. So which CPT codes are timed and which are untimed.
Untimed CPT Codes:
- Evaluation, Re-evaluation 97161, 97162, 97163
- Cold / Hot Packs 97010
- Unattended e-Stim 97014
Timed CPT Codes:
- Therapeutic Exercise – 97110
- Manual Therapy – 97140
- Neuromuscular Re-ed – 97112
- Therapeutic Activity – 97530
- Gait Training – 97116
- Ultrasound – 97035
- Iontophoresis – 97033*
- Electric Stim (manual) 97032
Yes, iontophoresis is considered a timed CPT code even though you almost always are not standing next to them while the ionto is running..
8 Minute Rule Examples
Let’s go through a few 8 minute rule examples. Remember, only timed minutes will count toward the 8 minute rule, regardless of the total treatment time (which may include untimed minutes like hot/cold pack). This is why the timed minutes are bolded below.
Example 1 Treatment:
- 15 min Therapeutic exercise
- 10 min Manual Therapy
Timed Minutes: 25
Total Treatment Time: 25 min
Untimed Minutes: none
Billable Units: 2 total units (1 Ther ex, 1 Manual)
Example 2 Treatment:
- 10 min Therapeutic Exercise
- 10 min Manual Therapy
- 10 min Hot Pack
Timed Minutes: 20
Untimed minutes: 10
Total Treatment Time: 30 minutes
Billable Units: 1 (Therapist may choose which CPT code)
In this example, we did not cross the 23 minute threshold for 2 units, so we can only bill 1 unit. As for which unit (ther ex or manual therapy) it’s up to the therapist based on their judgment – most will choose ther ex based on the higher reimbursement rate. If manual therapy was 11 minutes and ther ex was 9 minutes, you should ethically choose to bill manual therapy.
Example 3 Treatment
- 16 min Therapeutic Exercise
- 22 min Neuromuscular Re-ed
- 7 min Therapeutic Activity
Timed Minutes: 45
Untimed Minutes: 0
Total Treatment Time: 45 minutes
Billable Units: 3 (2 NM, 1 Ther ex)
The minutes we spend doing therapeutic activity still counts toward timed minutes because it is a timed code. We’ve clearly performed 1 unit of ther ex, but you’ll see that I marked 2 units of neuromuscular re-education. This might be confusing because 22 minutes does not cross the 23 minute threshold for 2 units, but I’m still charging 2 units of neuro re-ed.
This is because we bill units based on total timed minutes, which is 45 and equates to 3 billable units. I chose to bill 2 units of neuromuscular re-ed because it appeared that neuro re-ed was a larger focus in the treatment based on minutes spent.
Want to Save Time on Documentation?
If you’re interested in becoming more efficient with documentation and saving 30 to 60 minutes a day, check out the Therapy Documentation Templates for time saving examples and documentation phrases.
Questions on the 8 Minute Rule?
If you have any questions about the Medicare 8 minute rule, put them in the comments and we’ll try to answer them!