The 8-minute rule is a common standard in physical therapy billing services. It’s the main standard Medicare uses when reimbursing practices for outpatient and in-person therapy services. Some private payers also bill therapy services using the standard, but its variant, ‘Rule of Eights,’ is the most common. Continue reading to learn how the two standards work.
What Is the 8-Minute Rule?
The 8-minute rule is a standard that applies to the time-based CPT codes in physical therapy billing services. Under the standard, you bill outpatient, in-person service in units of 15 minutes. Any session is billable as long as it lasts at least 8 minutes. A service that lasts 8-22 minutes is one billable unit. If the same session lasted for 23-37 minutes, then you should bill it as two units of service.
If a patient receives more than one service, e.g., 15 minutes of manual therapy, 20 minutes of therapeutic activities, and 7 minutes of electrical stimulation (manual), the billable time would be 42 minutes (15 + 20 + 7). The billable units are three since the extra 12 minutes (after dividing 42 by 15) qualify as a unit.
Time-Based Versus Service-Based CPT Codes
The 8-minute rule applies only to time-based services. For a service-based session, you bill it as one unit regardless of the time you spend with the patient.
Here are examples of time-based and service-based codes:
Time-based CPT Codes
- Therapeutic exercise – 97110
- Therapeutic activities – 97530
- Manual therapy – 97140
- Gait training – 97116
- Electrical stimulation (manual) – 97032
Service-based CPT Codes
- Hot/cold packs – 97010
- Physical therapy evaluation (97161, 97162, or 97163) or re-evaluation (97164)
- Electrical stimulation (unattended) – 97014
A patient with 42 minutes of time-based therapy and 20 minutes of physical therapy evaluation would have 62 billable minutes. Under the 8-minute rule, the billable units would be four, not five. Unlike time-based billing, where you divide the total time by 15, you treat a service-based session as one unit.
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Billing Mixed Remainders
When billing for multiple patient sessions, you add the total time spent delivering the treatment and divide by 15. If the remainder exceeds eight, it qualifies as a billable unit. In most cases, the remainder comprises leftover minutes from multiple sessions. Assuming a patient spent 20 minutes in therapeutic exercise and 18 minutes in gait training, the excess minutes would be:
- Therapeutic exercise – Five (Twenty minus fifteen)
- Gait training – Three (Eighteen minus fifteen)
In this case, the billable units would be three. There’d be two for therapeutic exercise and one for gait training. When billing the remainder eight, you allocate it to the service with the highest number of leftover minutes.
8-Minute Rule Versus Rule of Eights
Other payers mostly use the rule of eights. While the 8-minute rule allows you to combine multiple services, the rule of eights calculates the units per service. Any service that lasts for less than eight minutes does not qualify for billing.
If a patient spent 15 minutes in manual therapy, 20 minutes in therapeutic activities, and 7 minutes in electrical stimulation (manual), you would bill two units, one unit each, for manual therapy and therapeutic activities since electrical simulation (manual) lasted for less than 8 minutes.
Importance of Automating Physical Therapy Billing Services
The 8-minute rule can be complicated, as it’s slightly different from the rule of eights. Automating your physical therapy billing services makes the process more convenient when distinguishing service-based and time-based codes. When looking for good billing software for your physical therapy company, consider one that can apply both types of billing while also double-checking your therapy bills for errors.
