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The Medicare 8-Minute Rule: Physical Therapy Billing Guide

Last Updated: November 4, 2025

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In outpatient physical and occupational therapy, you cannot bill a unit of time-based therapy just because you touched the patient. You must meet the strict mathematical requirements of the Medicare 8-Minute Rule.

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The Unit Calculation Chart

To bill time-based codes (97110, 97112, 97140, 97530), you add up the TOTAL one-on-one time spent across all time-based activities, and divide by 15. The remainder must be at least 8 minutes to bill the next unit.

  • 1 Unit: 8 to 22 minutes
  • 2 Units: 23 to 37 minutes
  • 3 Units: 38 to 52 minutes
  • 4 Units: 53 to 67 minutes

Compare CPT Codes

Confused between with vs. without contrast? Look up the official code descriptions.

Untimed Codes

Do NOT include the time spent on untimed codes (like PT Evaluations 97161, or unsupervised modalities like hot/cold packs 97010) in your 8-Minute Rule calculations.

Verify Medical Necessity

Don't risk a denial. See if your ICD-10 code is on the approved Medicare LCD list.

NCCI Edits

Medicare expects your billed units to match the total time logged. If you log 30 minutes of total treatment time but try to bill 3 units (which requires 38 mins), the claim will instantly deny.

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