8-Minute Rule Cheat Sheet

If you’re wondering about the Medicaid 8-minute rule and looking for an 8-minute rule cheat sheet, you’ve come to the right place. This article contains an 8-minute rule downloadable guide, with 8-minute rule billing requirements for clinicians. 

Understanding the 8-minute rule is a crucial aspect of operating a therapy practice that accepts insurance.

In order to seek insurance reimbursement, therapists and other service-based providers use current procedural terminology (CPT) codes, which dictate specific rules for conducting billable sessions. 

One of these rules is known as the 8-minute rule. It applies to direct outpatient services and is used by Medicare and Medicaid providers, in addition to many other public and private insurance companies that follow Medicare billing guidelines.

This 8-minute rule cheat sheet can make billing and administrative tasks a little less time consuming for clinicians.

How does the 8-minute rule work?

The 8-minute rule billing requirement allows practitioners who offer outpatient services to bill for a unit—referring to the duration of a service—so long as each unit billed for the service lasts a minimum of eight minutes and doesn’t exceed 22 minutes.

Practitioners who bill according to this rule include therapists, skilled nursing facilities, occupational therapists, rehabilitation facilities, home health agencies, and physical therapists. 

An 8-minute rule unit—also referred to as the “rule of eights”—refers to the 15-minute intervals of service, between 8 and 22 minutes, that qualifies as a unit when billing insurance. 

‌

8-minute rule table

This 8-minute rule downloadable guide includes a handy reference table to help you convert minutes of service into billable units. 

Duration of service Number of billable units8 to 22 minutes1 unit23 to 37 minutes2 units38 to 52 minutes3 units53 to 67 minutes4 units68 to 82 minutes5 units83 to 97 minutes6 units98 to 112 minutes7 units113 to 127 minutes8 units

Source: Medicare FAQ: Medicare 8-Minute Rule

When does the 8-minute rule start?

You can begin counting the moment you start providing skilled services—so long as the total time for services rendered exceeds eight minutes. This may include a diagnostic evaluation, individual psychotherapy session, or a reassessment. 

What are the 8-minute rule billing requirements?

Medicare’s 8-minute rule has specific billing requirements that therapists must follow, including:

• The clinician must have direct contact with the patient, i.e. the service must be in-person.
• Services are billed in 15-minute increments, with the first unit starting at the 8-minute mark (see above unit table). For example, if a session lasts 20 minutes, only one unit can be billed.
• If the service lasts less than eight minutes, Medicare cannot be billed.
• Mixed activities with different CPT codes cannot be billed together. 

‌

Time-based vs. service-based codes

Not all CPT codes are time-based. 

Certain codes relate to a service—like a psychiatric evaluation—rather than an individual psychotherapy session. 

In these situations, the evaluation would be billed as a service regardless of the time it took to complete, whereas time-based codes are billed in 15-minute units, as illustrated in the table above. 

Who does the 8-minute rule apply to?

In addition to Medicare, there are several organizations that use the 8-minute rule for CPT billing, including:

• Medicaid
• TRICARE
• Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)

‌

Other key information about the 8-minute rule

Not all insurance companies use the 8-minute rule. 

It’s important to check with the insurance company you’re intending to bill before seeking reimbursement.

Use this 8-minute rule cheat sheet to save time and energy billing insurance payers who follow the 8-minute rule. 

How SimplePractice streamlines running your practice

SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.

If you’ve been considering switching to an EHR system, SimplePractice empowers you to streamline appointment bookings, reminders, and rescheduling and simplify the billing and coding process—so you get more time for the things that matter most to you.

Try SimplePractice free for 30 days. No credit card required.

‌