Practice Management Blog

Understanding the 8-Minute Rule

Accurate documentation is crucial to efficient billing in allied health. It’s not just about jotting down notes; it’s the foundation for the reimbursement processes, ensuring practitioners are fairly compensated for the care provided.

In professions like physical therapy, understanding the 8-Minute Rule is critical. Essentially, the 8-Minute Rule is a tool for determining how many units to bill Medicare (US) for various outpatient services.

But why is it important?

Practices need to apply the 8-Minute Rule appropriately to ensure their billing procedures are accurate, and that Medicare will ultimately reimburse them for the services they provide.

If you haven’t tackled the 8-Minute Rule yet, don’t worry – we’ll break it down so you can use it effectively in your practice.

About the 8-Minute Rule

In healthcare billing, there are two main code types: time-based codes and service-based codes. When you understand the distinctions, you’ll be well on your way to mastering the 8-Minute Rule.

Service-Based Codes

Service-based codes are billed without taking time spent into account and typically represent a specific procedure or intervention. Service-based procedures often don’t necessitate one-on-one contact between the client and therapist. Examples of this kind of service for physical therapy may include unattended electrical stimulation or the application of a hot or cold pack.

Importantly, you can only bill one unit for a service-based code, regardless of the time it took to render the service.

Time-Based Codes

Time-based codes are billed based on the time spent providing a service to a patient.

This is where the 8-Minute Rule comes into play; although it isn’t complicated in principle, it can be confusing if you’re unfamiliar with it.

To bill for one unit of a time-based service, you must spend at least 8 minutes providing that service. If the service lasted 7 minutes, you can’t bill for that procedure.

For procedures that last between 8 minutes and 22 minutes, you’ll only bill for one unit. However, once you surpass the 22-minute mark, you must start to bill in 15-minute slots.

The 8-Minute Rule also applies to the total length of time of individual treatment. An appointment lasting less than 23 minutes will always be 1 unit, no matter how the procedures are divided. For example, if the total appointment lasts 20 minutes and you provide 10 minutes of therapeutic exercise and 10 minutes of manual therapy, you may only bill for one of the procedures as the total treatment time was not greater than 22 minutes.

Any extra minutes left over after adding up the 15-minute slots (over 22 minutes) are called “remainder minutes” or “mixed remainders”. If those remainder minutes add up to 8 minutes, you can bill for one more unit.

This means that a session lasting 14 minutes equates to one billable unit (8-minute minimum = 1 billable unit), and a session lasting 20 minutes also equates to one billable unit (the session lasted between 8 and 22 minutes). However, a session lasting 23 minutes equates to two billable units (15-minute slot + 8-minute slot).

Remainder Minutes or Mixed Remainders

As mentioned above, remainder minutes are the minutes left over after you’ve added 15-minute increments into billable units.

The term “mixed remainders” refers to remainder minutes from multiple services or codes. If these mixed remainders add up to eight minutes or more, Medicare allows you to combine the time spent into additional billable units. Medicare allows you to combine the time spent for all your services or procedures in a single appointment to determine your billable units.

8-Minute Rule vs Rule of Eights

While both the 8-Minute Rule and the Rule of Eights govern time-based billing, their nuances lie in the specifics of how they handle billing increments beyond the initial 22 minutes.

AMA’s Rule of Eights

The Rule of Eights, established by the American Medical Association, offers guidance on time-based billing for non-Medicare payors.

Under the Rule of Eights, a similar “1 unit = 8 minutes” rule applies; however, providers must bill per service, meaning that billing for mixed remainers isn’t allowed.

Each procedure code is allowed 1 unit for every 8 minutes entered. This system doesn’t transition to 15-minute increments like the 8-Minute Rule does.

For example, a treatment consisting of 10 minutes of therapeutic exercise and 20 minutes of manual therapy could be billed for 1 unit of therapeutic exercise and 2 units of manual therapy (depending on the payor).

8-Minute Rule

The 8-Minute Rule, as we’ve previously discussed, is a guideline used primarily in Medicare billing. It governs how time-based services are documented and billed, ensuring that providers are reimbursed fairly for the care delivered.

Under the 8-Minute Rule, providers must spend a minimum of eight minutes providing a service to bill for one unit. Additionally, once the 22-minute mark is surpassed, billing transitions to 15-minute increments.

For example, a treatment consisting of 10 minutes of therapeutic exercise and 20 minutes of manual therapy would be billed for 1 unit of therapeutic exercise and 1 unit of manual therapy.

Impact of the 8-Minute Rule on Your Practice

The 8-Minute Rule has tangible effects on physical therapy practice operations.

Benefit: Accurate Reimbursement

The primary benefit of following the 8-Minute Rule is ensuring that providers are fairly reimbursed for time spent with clients.

Practices can bill confidently for services rendered under Medicare by adhering to the rule’s guidelines. The secondary effect of this is a greater likelihood of accurate reimbursement.

Challenge: Potential for Lost Income

Navigating the 8-Minute Rule isn’t always straightforward. If documentation is unclear, or if billable units aren’t calculated correctly, practices risk losing out on potential income.

If your staff isn’t adequately trained in this billing procedure, services may not be properly documented, and time spent might not be tracked accurately. This can lead to under-billing and revenue loss.

Time is Money

  • Avoid Under-Billing: In physical therapy practices, time truly is money. Guard against under-billing, as this directly impacts your practice’s revenue stream. By implementing systems for accurate time tracking and documentation, practices can ensure that every minute spent with clients is accounted for and billed appropriately.
  • Ensure Accurate Time-Tracking: Use efficient time-tracking methods to comply with the 8-Minute Rule and maximize revenue. Whether it’s through notes in electronic medical records (EMR) systems or dedicated time-tracking software, investing in tools that streamline documentation and billing processes can help practices optimize their financial outcomes.

Strategies for Success

Prioritize accurate documentation, implement effective time-tracking practices, and stay informed about service codes so you can navigate the complexities of the 8-Minute Rule with confidence and ensure accurate reimbursement for the care you provide.

Here are some strategies to ensure success:

Accurate Documentation

Detailed and thorough documentation is the cornerstone of successful billing under the 8-Minute Rule. Ensure your notes reflect the time spent with clients, including all billable procedures and services rendered during each session. Implementing a note-taking template for each session can ensure consistency in your (and your staff’s) notes.

Time-Tracking Best Practices

Implement effective time-tracking methods to ensure compliance with the 8-Minute Rule. Providers should track the duration of each session and the specific services provided to accurately calculate billable units. Consistent and accurate time tracking not only facilitates billing, but enables practices to identify areas for improvement and optimize time management strategies.

Understanding Different Service Codes

To maximize reimbursement, familiarity with the various service codes and their eligibility under the 8-Minute Rule is critical. Providers should have a clear understanding of which services qualify for billing under the rule and how to properly document and bill for each one.

This may require ongoing education and training to keep staff updated on changes to billing guidelines and regulations.

8-Minute Rule Cheat Sheet

Now that we’ve delved into the nitty-gritty of how the 8-Minute Rule operates, here’s our cheat sheet for easy reference:


Although the 8-Minute Rule can seem challenging to navigate, if applied correctly, it ensures optimal reimbursement for physical therapists. Accurate and comprehensive documentation and time tracking make complying with this billing procedure much easier.

Be sure to stay informed about Medicare revisions to adhere to its requirements and maximize reimbursement for services.

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