When it comes to physical therapy for veterans, every minute matters — not just for recovery, but to make sure their care is properly counted and supported. That’s exactly what the 8-minute rule helps with.
Under rules set forth by the Centers for Medicare & Medicaid Services (CMS), 1 unit of a procedure billed would be understood to represent 8 minutes of one-on-one therapy, according to Medicare Part B guidelines. This standard—referred to as the “8-Minute Rule” – fosters appropriate billing and reasonable payment for outpatient therapy services, such as those delivered to veterans receiving treatment in drug rehabilitation programs.
Whether you’re receiving treatment or supporting a loved one at Resilience Behavioral Health in Highland Park, IL, understanding how this rule works can help you feel more confident in the process.
This guide walks you through the 8-Minute Rule in physical therapy in veterans drug rehab, and why it matters for both care and coverage. Let’s understand how this small rule can make a big difference in your journey toward better care.
What Is the 8-Minute Rule?
The 8-minute rule makes sure that therapists get paid fairly for the time they spend with patients. A therapist can bill for one unit if they spend at least 8 minutes with a patient one-on-one during an outpatient session. Everyone can see and understand it easily.
At Resilience Behavioral Health, this matters a lot, especially when working with veterans who receive personalized therapy plans. Knowing how this rule works helps make sure everything is billed correctly, so the focus stays where it should: on consistent, quality care.
Time-Based vs. Service-Based Units
Before we move on, let’s quickly go over the two main billing codes used in physical therapy.
|
Code Type |
What is Means |
|
Service-Based (Untimed) |
These are for tasks such as evaluations or applying hot or cold packs. No matter how long the session takes, you can only bill one unit for it. |
|
Time-Based (Direct Contact) |
These are billed in 15-minute blocks—but only if the therapist provides at least 8 minutes of hands-on, one-on-one care. |
At Resilience Behavioral Health, we use both types of codes, depending on what each veteran needs in their therapy plan. Additionally, this helps us keep care flexible, personalized, and accurate when it comes to billing.
How Billing Works: A Real-Life Example from Highland Park
According to CMS guidelines, if a therapist provides at least 8 minutes of one-on-one care beyond a complete 15-minute unit, they can bill for an additional unit of care. Let’s say a veteran at Resilience Behavioral Health gets two types of therapy:
- 15 minutes of therapeutic exercise
- 10 minutes of manual therapy
Now add both: 15 + 10 = 25 minutes.
Medicare allows you to bill one unit for every 15 minutes of direct care. That covers 1 unit, and you’re left with 10 extra minutes.
Since those leftover minutes are more than 8, you can bill another unit, making a total of 2 units.
This is exactly how the 8-minute rule works in real life. It makes sure that therapists are paid fairly for the time they spend with veterans and that veterans keep getting the care they need without any problems with billing.
Wondering what to pack for rehab? Check out our blog on What To Bring To Veterans Drug Rehab in Western Springs, IL.
What Happens When Time Doesn’t Fit Perfectly?
Sometimes, a therapist gives a few minutes of different treatments during a session, but none of them on their own go past 8 minutes. In this case, Medicare lets you add those leftover minutes together.
If the total adds up to 8 minutes or more, you can bill for the treatment that lasted the longest.
This small flexibility really helps—veterans can get the full value of their care, and clinics like Resilience Behavioral Health get paid fairly for the time they spend helping them heal.
Substantial Portion Method vs. Medicare’s 8-Minute Rule — What’s the Difference?
Every insurance company doesn’t follow the same billing rules. Here’s a quick look at how the two common methods are different.
1. Medicare’s 8-Minute Rule
- If a therapist gives at least 8 minutes of one-on-one care, they can bill 1 unit.
- Leftover minutes from different services can be combined.
- This method is followed by Medicare Part B and some other plans.
2. Substantial Portion Method (SPM)
- Used by some private insurers.
- Each service must be at least 8 minutes on its own to be billed.
- You can’t combine minutes from different services like you can with Medicare.
If you’re working with different insurance providers, it’s important to ask which billing method they use. Resilience Behavioral Health always follows the correct rules based on the patient’s insurance, even if it’s Medicare or a private plan—so billing stays accurate and stress-free.
How the 8-Minute Rule Ensures Fair Billing and Quality Care at Resilience Behavioral Health
Medicare is clear on how to bill for timed therapy sessions:
“For any single timed CPT code in the same day measured in 15‑minute units, providers bill a single 15‑minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.“
This rule applies nationwide, including Highland Park, IL. At Resilience Behavioral Health, we follow this guidance closely to make sure billing is transparent, so every minute of your therapy is properly counted.
FAQs
Q1: Who does the 8-minute rule apply to?
It applies to Medicare Part B, mainly for people getting outpatient therapy. At Resilience Behavioral Health, we use this rule, especially when treating veterans.
Q2: Can leftover minutes from different services be combined?
Yes! If the leftover minutes from different therapies total 8 minutes or more, you can bill one extra unit. Just bill it under the therapy you spent the most time on.
Q3: What’s the best way to avoid billing mistakes?
Yes. It’s important to track therapy time correctly and check the patient’s insurance guidelines. At Resilience Behavioral Health, we follow Medicare’s billing rules to make sure everything runs smoothly and without stress.
Ready to Experience Transparent and Compassionate Care? Contact Resilience Behavioral Health Today!
The 8-Minute Rule isn’t just a billing rule — it’s about making every minute of care count. At Veterans Drug Rehab in Highland Park, IL, it helps ensure veterans get the support they need without delays. And for providers, it keeps things clear and fair. In the end, it’s all about giving the best care, one minute at a time.
At Resilience Behavioral Health, we take these details seriously because they directly affect the quality of care our veterans receive. We are here to make sure nothing gets lost in the paperwork, so patients can focus on healing, and families can focus on support. If you want to start care you can trust? Contact Resilience Behavioral Health — we are here to help, listen, and guide you at every step.
