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November 26, 2025
8-Minute Rule Therapy Billing A Complete Guide
Navigating the 8-minute rule for therapy billing can be tricky, but mistakes lead to claim denials and lost revenue. This guide simplifies Medicare’s guidelines, ensuring accurate billing and compliance.
What is the 8-Minute Rule?
The CMS 8-minute rule determines how therapists bill Medicare for timed services (e.g., physical, occupational, or speech therapy). You bill one unit for every 8+ minutes of service, with total time dictating units:
- 1 unit: 8-22 minutes
- 2 units: 23-37 minutes
- 3 units: 38-52 minutes
How to Calculate Therapy Billing Units
- Track Time: Log minutes per CPT code (e.g., 97110, 97530).
- Apply the Rule: Divide total time by 15, then round down.
- Combine Services: Add time for multiple codes, but ensure each meets the 8-minute threshold.
Example: 25 minutes of therapeutic exercise (97110) + 12 minutes of manual therapy (97140) = 37 total minutes → 2 units.
Key Tips to Avoid Denials
Document Every Minute: Use EHR timers for accuracy.
Match CPT Codes: Verify codes align with Medicare’s covered services.
Audit Claims: Check for mismatched units and time.
Common Mistakes
- Billing a unit for <8 minutes.
- Overlapping untimed and timed codes.
- Ignoring state-specific Medicaid rules.
Therapy 8-Minute Rule Chart Example:
| Service Duration | Billable Unites |
|---|---|
| 8-22 | 1 |
| 23-37 | 2 |
| 38-52 | 3 |
| 53-67 | 4 |
| 68-82 | 5 |
| 83-97 | 6 |
As the healthcare landscape evolves, this chart remains an essential instrument in the toolkit of those committed to navigating the intricacies of healthcare billing with finesse.
