According to Medicare’s 8-Minute Rule, forms the foundation of billing for outpatient therapy. You get it wrong and risk denials, audits, or lost revenue. Get it right, and your clinic thrives. Let’s break it down in intense detail with real-world examples.
Medicare’s 8-Minute Rule is a billing formula for PT, OT, and Speech Therapy to convert treatment time into reimbursable units. It ensures clinics bill accurately for timed services (like therapeutic exercises) while preventing overcharging.
Example in Action:
Physical Therapy Session
Total Time Minutes | Billable Units | Common CPT Codes |
8–22 | 1 | 97110 (PT exercise), 92507 (SLP) |
23–37 | 2 | 97140 (manual therapy), 92526 (ST) |
38–52 | 3 | 97530 (orthotic training) |
53–67 | 4 | 97763 (prosthetic training) |
Pro Tip: Always round down! Therapy Service time 37 minutes = 2 units, not 3.
Example:
Case Study:
Pro Tip: Leverage billing systems like Therabill or WebPT to automatically determine units and identify errors.
CMS Reference: See Manual Chapter 5, Section 20.2 for the official documentation (PDF Here).
According to the 8-Minute Therapy Rule is important for healthcare providers provide outpatient therapy services. By accurately tracking time, following CMS guidelines, and make sure that compliance, you can avoid costly mistakes, prevent denials, and ensure proper reimbursement for the therapy services you provide.
Stay diligent with your documentation, use reliable billing software, and always keep up with payer-specific rules to streamline your billing process and improve revenue.
Same as PT/OT! Timed codes (e.g., 92507 for speech rehab) follow the 8–22-min threshold.
Yes! It’s another name for the 8-Minute Rule. Total timed minutes determine units.
No. This rule is specific to Medicare/CMS. AMA coding guidance is centered on CPT definitions rather than time-based billing.
Timing Range for 1 Unit: Services between 8 and 22 minutes. Exceed 22? Add another unit!
No. Medicare’s rule is precisely appropriate to PT, OT, and speech-language therapy services. Psych services use different billing guidelines.
Yes! Add their minutes (e.g., 10 + 15 = 25 → 2 units).
53 minutes = 3 billable units (per the 38–52 min range) plus 1 minute that cannot be billed.
Discover Cures Medical Billing Services Across Different States
FL
NY
ML
CO
NJ
AZ
TX
CA
WA
We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.
Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.
Discover unparalleled efficiency and precision in healthcare financial management with Cures Medical Billing Solutions.
© 2024 Created Cures Medical Billing Solutions, All copyrights Reserved
