February 12th 2024
By Ari Parker
Learn how the Medicare 8 Minute Rule affects healthcare billing and reimbursement. Discover its impact on providers and patients in this article.
By Ari Parker
Medicare, and other healthcare programs like TRICARE and Medicaid, use a billing guideline for physical therapy, occupational therapy, and speech-language pathology called the “8-minute rule.” This rule determines how much time a therapist spends with you during a single session and how to bill for that time. It ensures that healthcare providers accurately bill Medicare and that providers are compensated fairly.
We’ll explain how the Medicare 8-minute rule applies for common services like physical therapy and how Medicare bills it.
The Medicare 8-minute rule is a way that Medicare and healthcare providers measure and bill insurance for services related to physical therapy, occupational therapy, and rehabilitation.
Practitioners must spend at least 8 minutes on a service with a person before they can bill Medicare.
“Billable units” that Medicare pays are based on how much time healthcare providers spend on treatment. Check the chart below for specifics.
Healthcare providers use the Medicare 8-minute rule to bill Medicare based on the time they spend on a service. To bill Medicare, practitioners must provide a service for at least 8 minutes. If a physical therapist provides care for less than 8 minutes, Medicare won’t pay for the service.
Medicare uses “billable units” to measure how much they’ll have to pay based on the time a therapist spends on treatment. There are 8, 15-minute intervals of time that determine different billable units. This will all make more sense with the chart below:
| Column A | Column B |
|---|---|
| 8 to 22 minutes | 1 unit |
| 23 to 37 minutes | 2 units |
| 38 to 52 minutes | 3 units |
| 53 to 67 minutes | 4 units |
| 68 to 82 minutes | 5 units |
| 83 to 97 minutes | 6 units |
| 98 to 112 minutes | 7 units |
| 113 to 127 minutes | 8 units |
So if you spend 30 minutes in physical therapy, your therapist would bill Medicare for 2 units of service. The actual cost of each billable unit depends on the service and where you receive treatment.
The 8-minute rule applies only to in-person services where there is direct one-to-one contact. If you receive more than one service in one session, a healthcare provider bills Medicare per the time spent on each service. For instance, if you have 15 minutes of physical therapy and 20 minutes of occupational therapy, practitioners would bill Medicare for 35 total minutes, or 2 units.
You’ll see the 8-minute rule more commonly when you need:
Physical therapy: therapeutic exercises, manual therapy, neuromuscular re-education
Occupational therapy: improving activities of daily living, fine motor skills, sensory integration, adaptive equipment training
Rehabilitation services: orthopedic rehabilitation, rehabilitation for respiratory illnesses, neurological rehabilitation
Services related to speech language pathology: speech and language disorders, cognitive-communication impairments, voice disorders, swallowing disorders
You can find the Medicare 8-minute rule in settings like:
Private practices
Skilled nursing facilities
Rehabilitation facilities
Home health agencies that provide therapy services
You’ll encounter this rule anywhere Medicare provides coverage for an in-person therapeutic service.
The Medicare 8-minute rule is important for billing outpatient therapy services. The 8 minute rule ensures:
Accurate billing and fair compensation
Standard billing procedures between Medicare and healthcare providers
Transparency between Medicare and healthcare providers
Clear expectations for charges
People get the quality of care they need
The 8-minute rule doesn't impact the percentage of the cost of services you pay. It exists purely to establish the billing relationship between healthcare providers and Medicare. So, Original Medicare will still pay 80% of the bill, leaving you responsible for the remaining 20%.
Seeing real-life examples of how the rule works may help you understand it better. Here are situations that show how Medicare can apply the rule:
An occupational therapist works with Joe on fine motor skills for 15 minutes, followed by 20 minutes of adaptive equipment training. This totals 35 minutes, so Medicare is billed 2 units of service.
Mary attends a physical therapy session, but she can’t spend more than 5 minutes on it due to fatigue. Her session doesn’t meet the 8-minute rule, so her therapist can’t bill Medicare for the session.
If you have further questions about Medicare and the 8-minute rule, you can get in touch with your healthcare or insurance provider. A licensed Medicare Advisor can also help you with any Medicare-related concerns you have. Call us at 855-900-2427 or schedule a time to talk to get your Medicare questions answered.
