15 Tricky 8-Minute Rule Brain Teasers for Physical Therapists

In Arizona (where WebPT is headquartered), the summers are designated couch-time. It’s simply too hot for outdoor activities—unless you like cooking meals on the sidewalk or diving into a pool that’s roughly the same temperature as a jacuzzi. And even at a nice, temperature-controlled 78 degrees, actively moving around your living space will warm you up so much that even the thought of jumping in the jacuzzi-pool sounds tempting. But, every seasoned couch potato knows you can’t Netflix and chill the summer away without risking serious boredom. You gotta sprinkle in some brain teasers and puzzles to keep yourself sharp—and nothing teases the brain more than Medicare’s 8-Minute Rule.

So if you’re a therapist who’s looking to wile away the summer hours, improve your professional skills, and stay on your clinical toes, take a crack at these 8-Minute Rule brain teasers.

Hint: Check out this blog post if you need a quick refresher on the 8-Minute Rule. And remember, these scenarios are Medicare-specific!

Brain Teaser #1

One of your regular patients with low-back pain comes in for their regular appointment. During a single treatment session, you spend 20 minutes providing gait training and 20 minutes providing neuromuscular re-education. How many total units can you bill?

Answer #1

You can bill three units. Both of the services provided during this appointment (CPT codes 97116 and 97112, respectively) are timed. To calculate how many units to bill, add up the time spent providing each service for a sum total of 40 minutes. That equals three billable units: two units of one CPT code, and one unit of the other (how you split them up is your choice).   

Brain Teaser #2

During a patient’s treatment session, you provide ultrasound for five minutes and manual therapy for seven. How many total units can you bill for these services?

Answer #2

You can bill one unit. Once again, both of the services provided during this appointment (CPT codes 97035 and 97140) are timed—which means you may bill one unit for the cumulative 14 minutes spent providing treatment. Since you provided manual therapy for a longer duration, bill one unit of 97140.

Brain Teaser #3

True or false: You must always calculate billable units using Medicare’s 8-Minute Rule—no matter the payer.

Answer #3

False. While many payers use some version of the 8-Minute Rule—not all do. Instead, some follow the AMA’s rule of eights. Be sure to follow the correct rule for each payer, because despite having similar namesakes, the 8-Minute Rule and the rule of eights are not the same!

Brain Teaser #4

True or false: Mechanical traction is considered a timed service.

Answer #4

False. Mechanical traction (CPT code 97012) is not considered a timed service. As such, you can bill only one unit of mechanical traction per patient per date of service—regardless of how much time you spend providing this service.

Brain Teaser #5

On a single date of service, you spend a total of 50 minutes providing a patient with timed therapy services. What is the maximum number of timed units you can bill?

Answer #5

You may bill three units. Remember, the 8-Minute Rule states that 15 minutes of treatment comprises one unit. If you divide 50 minutes of treatment time by 15 minutes, you get three units with a remainder of five minutes. Since your remainder is just shy of 8 minutes, you cannot round up to 15—and you cannot bill a fourth unit.

Brain Teaser #6

During a single treatment session, you spend seven minutes performing gait training and 18 minutes providing therapeutic exercise. How many total units can you bill for these services?

Answer #6

You may bill two units. When performing multiple timed services during a single treatment session, you must add together your total number of timed minutes to determine the number of units to bill. Per Medicare’s rules, 25 minutes of total treatment time supports two units—one of gait training (CPT code 97116) and one of therapeutic exercise (CPT code 97110). 

Brain Teaser #7

True or false: You can include the minutes you spend performing service-based (a.k.a. untimed) treatments as part of your total timed treatment minutes.

Answer #7

False. You can only bill one unit of each service-based treatment you provide—regardless of how many minutes you spend delivering that treatment. So, when adding up your total timed treatment minutes, omit the minutes you spent providing service-based (or untimed) treatments.

Brain Teaser #8

A new patient comes in complaining of pain and stiffness in their left arm and hand. You spend 45 minutes providing an initial evaluation. How many units can you bill?

Answer #8

You may bill one unit. Initial evaluations (CPT codes 97161–97163) are untimed services. Thus you can bill only one eval unit per patient per date of service—regardless of how long you spent conducting the service.

Brain Teaser #9

During a single treatment session, you provide 20 minutes of therapeutic exercise and five minutes of manual therapy. How many units can you bill for each service?

Answer #9

You may bill two total units—but you could distribute your units in one of two ways. Because you provided a total of 25 minutes of timed treatment, you can bill two units—one for therapeutic exercise (CPT code 97110) and one for either the leftover five minutes of therapeutic exercise or the five minutes of manual therapy (CPT code 97140). In situations like this, experts typically advise billing for the service that benefits the patient the most. 

Brain Teaser #10

During a single treatment session, you provide a patient with 25 minutes of therapeutic exercise, 10 minutes of manual therapy, five minutes of electrical stimulation (attended), and 10 minutes of hot/cold pack therapy. How many total units can you bill?

Answer #10

You may bill four units. Therapeutic exercise (97110), manual therapy (97140), and manual (or attended) e-stim (97032) are all considered timed services, meaning your timed treatment total would be 40 minutes. That’s good for three units! The hot/cold pack application is an untimed service, giving you another single billable unit and bringing your grand total to four units.

Brain Teaser #11

On a single date of service, you provide 30 minutes of therapeutic exercise, 15 minutes of manual therapy, eight minutes of gait training, and 15 minutes of electrical stimulation (unattended). How many total units can you bill?

Answer #11

You may bill five units. Therapeutic exercise, manual therapy, and gait training (CPT codes 97110, 97140, and 97116, respectively) are all timed services, so your timed treatment total would be 53 minutes—which is good for four units. Add on one additional unit for unattended e-stim (97014)—an untimed, service-based treatment—bringing your billable total to five units.  

Brain Teaser #12

During a single appointment, you provide a patient with 20 minutes of therapeutic exercise, five minutes of gait training, five minutes of therapeutic activity, eight minutes of manual therapy, and 10 minutes of mechanical traction. How many units can you bill for each service?

Answer #12

You may bill four total units: one for therapeutic exercise (97110), one for manual therapy (97140), one for mechanical traction (97012), and one for either gait training (97116), therapeutic activity (97530), or therapeutic exercise (97110). 

This one’s a bit tricky, so let’s break it down. Let’s start with timed units: In total, you provided 38 minutes of timed treatment (for the therapeutic exercise, manual therapy, gait training, and therapeutic activity) and 10 minutes of untimed treatment (for the mechanical traction). This 38 timed minutes support three units: one for the 20 minutes of therapeutic exercise, one for the eight minutes of manual therapy, and one that encompasses all of the five-minute “partials” (i.e., the five-minute remainder of therapeutic exercise, the five minutes of gait training, and the five minutes of therapeutic activity). While technically you could slot this unit under any one of those three services, most billing experts advise billing for the service that benefits the patient the most.

Brain Teaser #13

On a single date of service, you provide a patient with seven minutes of therapeutic exercise, seven minutes of neuromuscular re-education, and seven minutes of manual therapy. How many units of each service can you bill?

Answer #13

You may bill one unit of one of the three services provided. Each of the services provided (CPT codes 97110, 97112, and 97140, respectively) are timed. After adding all of their time together, you’re left with a total of 21 minutes—which justifies only one unit. Since you furnished each service for an equal number of minutes, you can choose which service to bill (though experts advise billing for the service that benefits the patient most.)

Brain Teaser #14

On a single date of service, you provide a patient with 20 minutes of therapeutic exercise and five minutes of gait training. How many units of each service can you bill?

Answer #14

You may bill two total units—but you could distribute your units in one of two ways. In total, you provided 25 minutes of timed treatment, which accounts for two billable units. For the 20 minutes you spent providing therapeutic exercise (97110), you may bill one unit—though you’ll be left with a five-minute remainder. Then, because your five-minute remainder and the 5 minutes of gait training (97116) add up to more than 8 minutes, you may bill one additional unit. 

Since you provided each service for an equal number of minutes, you can decide which CPT code to bill (though most billing experts advise billing for the service that most benefits the patient).

Brain Teaser #15

To follow up on the previous question, let’s say you instead provide 18 minutes of therapeutic exercise and five minutes of gait training. Would this change your billing—and if so, how?

Answer #15

Yes, this could change your billing. In this new scenario, you provided 23 minutes of timed services, which supports two billable units. However, you would have to bill one unit of therapeutic exercise (97110) and one unit of gait training (97116). This is because, after you account for one 15-minute unit of therapeutic exercise, you’re left with a remainder of three minutes of therapeutic exercise and five minutes of gait training. Of these two services, you devoted more time to gait training—which means you would bill that over therapeutic exercise. 

Phew! Does your brain feel adequately teased and sharpened? I know mine does! And while cracking away at 8-Minute Rule scenarios might not be as fun as, say, watching Gilmore Girl reruns for the sixth time, it’s an excellent way to brush up on your clinical skills while chipping away at those long summer days.

Got any 8-Minute Rule brain busters you’re trying to solve? Feel free to drop ‘em below, and our team will do its best to find you an answer!