Medicare and the 8-Minute Rule

What Is the Medicare 8-Minute Rule?

The Medicare 8-minute rule is a billing guideline established by the Centers for Medicare & Medicaid Services (CMS) that governs how providers bill for time-based therapeutic services. Under this rule, a provider must spend at least 8 minutes delivering a timed service in order to bill Medicare for one unit of that service.

The rule applies to physical therapy, occupational therapy, speech-language pathology, and other timed therapeutic procedures billed under Medicare Part B. It does not apply to untimed (service-based) codes, which are billed once per session regardless of time spent.

Who Does the 8-Minute Rule Apply To?

The 8-minute rule applies to any Medicare-participating provider who bills for timed therapeutic procedures under the Medicare Physician Fee Schedule. This includes:

• Physical therapists (PTs) and physical therapy assistants (PTAs)

• Occupational therapists (OTs) and occupational therapy assistants (OTAs)

• Speech-language pathologists (SLPs)

• Certified athletic trainers billing under a physician's supervision

• Other providers billing timed therapeutic procedure codes

The rule applies in all outpatient settings, including private therapy practices, hospital outpatient departments, skilled nursing facilities, and home health agencies, wherever timed CPT codes are billed to Medicare Part B.

How Billing Units Are Calculated

Each timed therapeutic service is billed in 15-minute units. The 8-minute rule determines how many units a provider can bill based on the total time spent. The key principle: a provider must spend at least 8 minutes on a service to bill for one unit, and at least 8 additional minutes beyond a full unit to bill for the next unit.

Common Therapy CPT Codes and What They Cost in 2026

Understanding which CPT codes your therapist bills helps you predict your out-of-pocket costs. Below are the most common timed therapy codes subject to the 8-minute rule, along with their 2026 Medicare-approved amounts per unit:

What a Typical PT Session Costs You

A standard 45-minute physical therapy session typically generates 3 billable units. Here is what that session costs under different Medicare coverage scenarios, assuming the provider bills 2 units of therapeutic exercise (97110) and 1 unit of manual therapy (97140):

Over a typical course of treatment (12 to 24 sessions), the difference adds up. A beneficiary on Original Medicare alone would pay approximately $235 to $469 in coinsurance. With Medigap Plan G, the total out-of-pocket cost for the entire course of therapy is $283 (the annual deductible) regardless of how many sessions you attend.

How to Read Your Physical Therapy Bill

After each therapy session, your provider submits a claim to Medicare. You will receive a Medicare Summary Notice (MSN) showing what was billed. Here is how to interpret the key fields:

1. Date of Service: The date you received treatment.

2. CPT Code: The 5-digit procedure code (e.g., 97110 for therapeutic exercise). Each timed code represents one 15-minute unit.

3. Units: The number of billing units charged. A "3" next to CPT 97110 means 3 units (45 minutes) of therapeutic exercise.

4. Charges: What the provider billed. This is often higher than the Medicare-approved amount.

5. Medicare-Approved Amount: The maximum Medicare allows for the service. This is the number that matters for your cost-sharing.

6. Medicare Paid: 80% of the approved amount (after your deductible is met).

7. You Owe: Your 20% coinsurance, or $0 if Medigap covers it.

How to Dispute a Therapy Bill

If you believe your physical therapy bill is incorrect, you have the right to challenge it. Medicare has a formal appeals process, but many billing errors can be resolved before reaching that stage.

1. Request an itemized bill. Ask your provider for a detailed statement showing each CPT code, the number of units, and the time spent on each service. Compare this to your own records of the session.

2. Ask for the treatment log. Your therapist is required to document the exact minutes spent on each timed service. Request a copy and compare it to the units billed.

3. Contact the billing department. Many overbilling issues are clerical errors. Call the provider's billing office, explain the discrepancy, and ask for a correction.

4. Call Medicare. If the provider will not correct the bill, call 1-800-MEDICARE (1-800-633-4227) to report the issue. Medicare can review the claim and request an adjustment.

5. File a formal appeal. If you receive a Medicare Summary Notice showing a charge you disagree with, you have 120 days to file a redetermination request with your Medicare Administrative Contractor (MAC). Instructions are printed on the MSN itself.

If you suspect intentional fraud (billing for services never provided, or consistently inflating units), you can report it to the HHS Office of Inspector General at 1-800-HHS-TIPS or online at oig.hhs.gov.

Timed vs. Untimed Procedure Codes

Not all therapy procedures are subject to the 8-minute rule. Procedures are classified as either timed or untimed (service-based):

What the 8-Minute Rule Means for Your Medicare Coverage

Under Medicare Part B, outpatient physical therapy and other timed therapeutic services are covered at 80% of the Medicare-approved amount after you meet your annual Part B deductible ($283 in 2026). You are responsible for the remaining 20% coinsurance.

Because billing is based on units rather than a flat per-session rate, the number of units billed directly affects your out-of-pocket cost for each visit. A session with more timed procedures will generate more billable units and a higher cost-sharing amount for you.

If you have a Medicare Supplement (Medigap) plan, your plan will typically cover the 20% Part B coinsurance, significantly reducing your out-of-pocket costs for therapy sessions. Medicare Advantage plans may have different cost-sharing structures, such as a per-visit copay instead of 20% coinsurance.

Therapy Spending Thresholds in 2026

Medicare Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology services when they are medically necessary. There is no hard annual dollar cap on therapy services in 2026. The therapy cap that existed prior to 2018 was permanently eliminated by the Bipartisan Budget Act of 2018.

However, Medicare applies two important thresholds in 2026:

• KX modifier threshold: $2,480. Once your therapy claims for the year exceed $2,480 (for PT and SLP combined, or $2,480 for OT separately), your provider must add the KX modifier to each claim certifying that continued treatment is medically necessary. This increased from $2,410 in 2025.

• Targeted medical review threshold: $3,000. Claims exceeding $3,000 per year may be selected for additional review by Medicare to confirm medical necessity. This threshold has been in place since 2018 and remains unchanged through 2028. Not all claims exceeding this amount will be reviewed.

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