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.