Why Seniors Shouldn't Ignore Medicare's '8-Minute Rule'

Senior living can mean finally getting the chance to enjoy the best budget vacation destinations in the United States or moving to one of the best states to retire, but it can also come with more physical therapy appointments. Those living through their golden years may be frustrated with needing new care as they age, and sorting through Medicare billing information can be puzzling. One point of confusion for many is Medicare's "8-minute rule," which comes into play with physical therapy bills.

Medicare's "8-minute rule" is a bit of math most physical therapists use to keep their billable time productive. In very short order, a physical therapist must perform direct, face-to-face care for a minimum of eight minutes in order to bill Medicare for one unit of service. Medicare allows billable units in 15-minute increments, requiring a minimum of eight minutes of directly provided service to count for billing.

This means one Medicare-billable unit of physical therapy must be at least eight minutes — and up to 22 minutes — in length. If the services the physical therapist provides are under eight minutes, that therapist cannot bill Medicare for that service, since it falls under the eight-minute minimum. Of course, appointments are rarely scheduled for a tight eight minutes of physical therapy. Making sure the math works takes a little understanding, and perhaps a bit of self-advocacy on the patient's part.

The 8-minute rule was first enforced by the Centers for Medicaid and Medicare Services (CMS) in April 2000. Those 65 and up who receive outpatient physical therapy are impacted by Medicare's 8-minute rule. Primarily, this minimum is used just to help physical therapists bill Medicare for the services they provide their patients accurately, and to get Medicare — not the patient or hospital — to cover the costs.

The eight-minute minimum helps providers keep their services on track with their payments. Rather than provide a 22-minute therapy session that would only be covered as one unit by Medicare, a physical therapist may conduct a 25-minute session, and bill Medicare for two units of service. The rule of thumb for a patient to remember is that, at minimum, one unit of direct, in-person care must fall between eight and 15 minutes. Exceptions to this include any group therapy provided by physical therapists, which is billed differently.

Sometimes, the mixed remainders of a number of provided services can be added together to be billed for one unit of service to be paid by Medicare. This could be a stray overage of minutes of physical therapy, added with assessment and management services, that make one billable unit. While it may be overwhelming for a patient to learn all of the codes associated with billing Medicare, it can help prevent the patient from being accidentally overbilled or underserviced.

If the Medicare 8-minute rule sounds confusing to beneficiaries, don't worry — it's also plenty confusing to providers, as well. Many online message boards are filled with questions about the rule and how to bill appropriately. If you are a senior receiving direct outpatient physical therapy — or someone close to such a beneficiary — keep in mind that most service providers want to give the best care possible, and receive appropriate payment for that care.

However, if, as the patient, you feel too rushed during physical therapy services or like direct care is minimized due to billable units, it may be helpful to ask your provider or doctor how you can get more therapeutic time on the clock. It may also help to check with providers if it feels like copayments are too high for certain Medicare plans. Starting any sort of conversation or asking questions about billing may help straighten things out for patients and providers, however seemingly awkward starting such a conversation may be.

These dialogues may be essential for all patients and providers going forward, as medicare is undergoing big changes. There are many costs Medicare won't cover, and terrible cuts have slashed Medicare benefits in 2025. Two major healthcare companies are even bailing on Medicare Advantage in some regions. H.R.1 legislation from the Republican-led "One Big Beautiful Bill" could have significant impacts on Medicare funding as well. So, don't be afraid to speak up.