8-minute rule cheat sheet

If you're wondering about the Medicaid 8-minute rule and looking for a cheat sheet, you've come to the right place. This 8-minute rule cheat sheet doubles as a downloadable guide, with the billing requirements clinicians need for accurate reimbursement.

Understanding how the 8-minute rule works is an important part of operating a therapy practice that accepts insurance. This downloadable 8-minute rule guide breaks down exactly what's required. 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 downloadable 8-minute rule cheat sheet can make billing and administrative tasks a little less time-consuming for clinicians.

Important note for mental health clinicians: Standard individual psychotherapy CPT codes (such as 90832, 90834, and 90837) use CPT-defined time brackets per session (e.g., 38–52 minutes for 90834) and do not use the 15-minute unit-stacking method described in this guide. The 8-minute rule applies specifically to 15-minute time-based rehabilitation codes (PT, OT, SLP).

How does the 8-minute rule work?

How does the 8-minute rule work, in plain terms? This billing requirement allows practitioners who offer outpatient services to bill for an 8-minute rule unit—referring to the duration of a service—so long as the 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 refers to the 15-minute intervals of service, between 8 and 22 minutes, that qualify as a unit when billing insurance. Note that this is different from the AMA's "Rule of Eights," covered below—the two terms are frequently confused, but they describe different calculation methods.

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.

Source: MedicareFAQ (2026). Medicare 8-minute rule explained.

What are the main steps to follow?

Using this 8-minute rule cheat sheet comes down to a few repeatable steps:

• Track the exact start and stop time of each timed, skilled service you provide.

• Add up the total minutes across all timed CPT codes delivered in that visit.

• Divide the total by 15 to find your base number of units.

• Check the leftover minutes against the 8-minute rule table above—8 or more rounds up to another unit; 7 or fewer doesn't.

• Bill only for minutes of direct, one-on-one skilled contact, not documentation or setup time. Since this is a downloadable 8-minute rule guide, keep a copy on hand for quick reference during billing.

Example: How many units would you bill?

The 8-minute rule's unit-stacking table above applies to timed PT, OT, and SLP treatment codes—not to standard individual psychotherapy codes. Say a physical therapist provides 53 minutes of therapeutic exercise in one session. Using the 8-minute rule table above, 53 to 67 minutes converts to 4 billable 8-minute rule units.

8-minute rule vs. the Rule of Eights

This isn't the only time-based billing method clinicians run into. The American Medical Association's Rule of Eights, sometimes called the midpoint rule, works similarly but applies the 8-minute threshold separately to each individual timed CPT code, rather than combining total treatment minutes the way Medicare's version does. Many commercial payers use the AMA method, so it's important to confirm which version a given payer follows before you bill. 

This 8-minute rule cheat sheet reflects Medicare's version, since that's the version most clinicians bill under most often. 

When does the 8-minute rule start?

You can begin counting the moment you start providing a timed, skilled service—so long as the total time for that service exceeds eight minutes. This may include a physical or occupational therapy treatment, a speech-language pathology session, or a reassessment billed under a timed code. 

‌

What are the 8-minute rule billing requirements?

How does the 8-minute rule work when a session includes more than one timed CPT code? 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 the unit table above). 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 for that service.

• When a clinician provides more than one timed CPT code in a single visit, the total minutes across those codes are generally combined to determine the number of billable units. If the combined leftover ("remainder") minutes from multiple codes add up to 8 or more, that extra unit is billed under whichever code had the largest individual remainder—a process often called "mixed remainders." These 8-minute rule billing requirements also apply to how mixed codes are calculated.

Time-based vs. service-based codes

Not all CPT codes are time-based.

Certain codes relate to a service—like a psychiatric diagnostic evaluation—rather than a timed treatment session. In these situations, the evaluation is billed as a single service regardless of how long it took to complete, whereas time-based codes are billed in 15-minute units, as illustrated in the table above.

Are there exceptions to the 8-minute rule?

Yes. This rule generally doesn't apply to service-based codes, and group therapy isn't calculated through the 8-minute rule's timed-unit method either. Telehealth is a separate consideration: the unit math still generally applies to timed services delivered via telehealth, but telehealth billing carries its own fast-changing requirements around place-of-service codes, audio-only rules, and eligibility, so confirm those separately from the unit calculation itself. 

It's always worth confirming exceptions with the specific payer before billing.

Who does the 8-minute rule apply to?

In addition to Medicare, other organizations use this billing rule, including Medicaid and TRICARE (the health program that succeeded CHAMPUS, the Civilian Health and Medical Program of the Uniformed Services, in 1994). The Medicaid 8-minute rule generally mirrors CMS's total-time methodology, though this can vary by state. 

Who benefits most from using this rule?

Clinicians and practice owners who bill time-based CPT codes to Medicare, Medicaid, or payers that follow Medicare's billing guidelines benefit most from an 8-minute rule cheat sheet like this one, since it removes the guesswork from converting session minutes into billable units. Solo and group practices with high session volume, and newer billing staff who are still learning the CPT code system, tend to see the biggest reduction in calculation errors. 

If your practice only bills service-based codes or payers that don't follow this methodology, the rule has limited relevance to your billing workflow.

Other key information about the 8-minute rule

Not every insurer follows this rule. This 8-minute rule cheat sheet won't help if your payer doesn't use this method at all, so 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.

Sources

• Centers for Medicare & Medicaid Services. (2024). Medicare claims processing manual 

• Centers for Medicare & Medicaid Services. (2026). Therapy services.

• Haass, D. (2026). Medicare and the 8-minute rule. MedicareFAQ.

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.

‌