Medicare Physical Therapy 8 Minute Rule

Medicare Physical Therapy 8 Minute Rule

The 8-minute rule is a billing guideline used by physical therapists (PTs) in the United States when submitting claims for reimbursement to Medicare and some private insurance companies. It helps PTs determine how many billable units they can charge for each timed, one-on-one therapeutic intervention they provide to a patient during a single session. Medicare Physical Therapy 8 Minute Rule is designed to keep seniors and physical therapists equally timed for billing.

What is the 8 minute rule in physical therapy

The 8-minute rule is based on 15-minute increments, where each increment is considered one billable unit. To bill for one unit, the therapist must provide at least 8 minutes of a timed service. If the service lasts less than 8 minutes, it cannot be billed as a full unit. Here’s a breakdown of how the rule works:

  • 1 unit: 8 to 22 minutes of therapy
  • 2 units: 23 to 37 minutes of therapy
  • 3 units: 38 to 52 minutes of therapy
  • 4 units: 53 to 67 minutes of therapy
  • 5 units: 68 to 82 minutes of therapy
  • 6 units: 83 to 97 minutes of therapy

How Does the 8-Minute Rule Impact Physical Therapists?

To apply the 8-minute rule, PTs should keep track of the time spent on each intervention during a session. They should then add up the minutes for all timed services, and determine the appropriate number of billable units based on the total time.

It’s important to note that the 8-minute rule applies only to timed, one-on-one therapeutic interventions, such as therapeutic exercises, manual therapy, or neuromuscular reeducation. It does not apply to untimed or bundled services, like evaluations, modalities, or group therapy sessions.

Medicare 8 ‘minute rule

According to this rule, in order to bill for one unit of therapy, the therapy session must last for at least 8 minutes. If the session is shorter than 8 minutes, it cannot be billed separately and must be combined with another session to meet the 8-minute threshold.

For example, if a patient receives physical therapy for 20 minutes, the provider can bill for 2 units of therapy. However, if the patient only receives 5 minutes of therapy, the provider cannot bill for that session alone and must combine it with another session to meet the 8-minute threshold.

How many days of physical therapy will Medicare cover?

Medicare coverage for physical therapy depends on the individual’s medical condition and needs. Medicare will cover physical therapy as long as it is medically necessary and ordered by a doctor or other healthcare provider.

There is no specific limit on the number of days of physical therapy that Medicare will cover. However, there are limits on how much therapy Medicare will cover in a given period of time. For outpatient physical therapy, Medicare will cover up to 100 therapy sessions per year.

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Posted on May 2023