Getting paid for your work as a physical therapist isn’t just about providing great care but also about billing correctly.
Physical therapy billing can be confusing, especially with different rules for Medicare, commercial payers, and workers’ comp. But the #1 rule you need to understand is the 8-Minute Rule.
Here’s what PT clinics need to know to bill accurately, stay compliant, and maximize reimbursement.
1. What is the 8-Minute rule in Physical therapy?
The 8-Minute Rule comes from Medicare and determines how many timed CPT codes you can bill for a single treatment session.
You can bill 1 unit of a timed service if you provide at least 8 minutes, and more units for longer sessions.
You add all timed minutes together (from services like therapeutic exercise or manual therapy) and then apply the chart. Do not include non-timed codes (like evaluations or unattended e-stim) in this calculation.
2. Which CPT Codes are TimeD vs. Untimed?
Timed CPT Codes:
97110: Therapeutic Exercise
97140: Manual Therapy
97530: Therapeutic Activities
97112: Neuromuscular Re-ed
Untimed CPT Codes:
97001: Evaluation (initial)
97002: Re-evaluation
97014: Unattended E-stim
You can only bill one unit of an untimed code per day per patient, regardless of time spent.
3. Medicare vs. commercial Payers
While Medicare strictly follows the 8-Minute Rule, some commercial insurers follow a different method, such as billing based on each individual CPT code's time, not total time across all.
Make sure your billing team checks each payer’s rules and contracts to avoid denials or overbilling.
4. Documentation must support time & Services
To justify the units you bill:
1. Document the start/stop times or total time per service
2. Include objective goals, progress and medical necessity
3. Ensure the plan of care is signed by the referring provider (especially for Medicare)
4. Insufficient documentation is a leading reason for denied or clawed-back payments
5. PArtnering for better reimbursement
The best billing strategy combines clinical excellence with administrative precision. BOOST partners with PT clinics to help ensure proper coding, documentation and reimbursement, especially for complex claims like workers’ comp and auto injury. Billing doesn’t have to be a guessing game.
Learn how BOOST supports PT clinics in getting paid accurately, completely and on time.