Running a physical therapy practice is a huge challenge, particularly when it comes to compliance. One often misunderstood regulatory issue is the Medicare rule of 8. Simply put, the Medicare Rule of 8, or the ‘8 minute rule,’ is a billing regulation created by the Centers for Medicare and Medicaid Services (CMS). Although it may seem that this means you can bill for every eight minutes of treatment, that’s not exactly what the 8 minute rule implies.

Instead, the Medicare rule of 8 refers to how you time your physical therapy services. According to this regulation, you can only bill Medicare and Medicaid for time that you are actively attending the patient. So, for example, if you have a physical therapy aid providing services, this would be considered unskilled time, and is thus not billable. Additionally, if the patient is otherwise resting, changing, or waiting for equipment, then you can’t bill for that time.

How To Measure a Unit of Skilled Care

Fortunately, applying the Medicare Rule of 8 isn’t that complex. The National Government Services website has laid out units pretty precisely, which is the metric you use to bill CMS.  In this system, every unit represents a 15 minute increment. For example, one minute represents between 8 minutes and 22 minutes of skilled treatment, while two units represents between 23 and 37 minutes. Each subsequent unit is another 15 minute increment past that, and gives a precise measure of how much you can bill CMS.

How To Assign Codes Appropriately

This is, of course, pretty straightforward if every individual physical therapy treatment falls neatly into a 15 minute increment. However, this is rarely the case. To make up for this, CMS created a code system to know which treatments to bill for in which units. If, for example, you perform 48 minutes of skilled treatment based on 25 minutes of therapeutic activities and 23 minutes of threptic treatment, then you would want to bill for 3 units. However, you would only be able to bill for 1 unit of therapeutic exercise and 1 unit of therapeutic activities, and you’d have an extra 10 minutes of therapeutic activities remaining and 8 minutes of therapeutic treatment unaccounted for.

To figure out how exactly to bill this third unit, you would need to bill for where you spent the most time in treatment, which in this case would be therapeutic activities. Therefore, to apply the Medicare Rule of 8 in this instance, you would take the additional 18 minutes from both treatment options and add it to the therapeutic activities unit, as that is area where you have given more treatment overall, even if it’s only by a few minutes.

Working with CMS is complex as a physical therapist, but the Medicare Rule of 8 system aims to simplify the billing process and make it so that you can focus more on the type of treatment that an individual patient needs the most. After all, that is why all physical therapists should have gotten in the business in the first place – to help patients recover from ailments and injuries and return to the life they want to live.