Specialized billing for physical therapy practices — timed procedure coding, therapy cap management, and PT revenue cycle management. Serving practices nationwide across the United States.
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Accurate 8-minute rule application for timed therapy codes, ensuring maximum units are billed based on treatment time documented.
Tracking Medicare therapy caps, applying KX modifiers for medically necessary services exceeding the cap, and managing exceptions.
Accurate G-code reporting for functional limitation severity and discharge status required for Medicare PT billing.
PT denials for medical necessity and documentation issues are appealed with functional outcome measures and clinical notes.
Managing authorization requirements for PT visits, tracking visit limits, and requesting extensions when medically necessary.
Monthly reports on units per visit, collections per visit, payer mix, and therapist productivity.
PT billing is arithmetic under audit: timed codes governed by the 8-minute rule, visit counts governed by plans of care and payer thresholds, and payment differentials based on who delivered each minute of treatment. No specialty has a tighter link between documentation habits and revenue — and none gets audited on that link more routinely. Disciplined PT billing is mostly about making the minutes defensible.
Timed CPT codes bill in 15-minute units, and Medicare's 8-minute rule decides how documented minutes convert to billable units across all timed services in a visit. Total the timed minutes, divide, apply the remainder rule — and reconcile against per-service minutes in the note. Commercial payers may follow Medicare's math or substitute their own (some count per service, not in aggregate). Unit errors in either direction are chronic in PT: undercounting gives away treatment; overcounting is the finding auditors love most.
Evaluations, re-evaluations, unattended modalities, and supervised modalities bill once per session regardless of duration; therapeutic exercise, manual therapy, and neuromuscular re-education bill by time. The daily mix matters: payers watch for template billing (the same four codes every visit, every patient) and for combinations their edits bundle. Treatment notes that support each code's distinct skilled service — not just its minutes — are what keep the mix paid.
Medicare PT runs on paperwork checkpoints: a plan of care certified by the referring provider (and recertified on schedule), progress notes at required intervals, and treatment consistent with the certified plan. Miss a certification window and every visit after it is technically unbillable — a five-figure problem discovered in audit, not in the EOB. We track certification and progress-note deadlines per patient the way we track authorizations: as revenue infrastructure.
Above Medicare's annual therapy threshold, claims need the KX modifier attesting continued medical necessity — with documentation that genuinely supports it — and above a higher threshold, targeted medical review becomes possible. The KX isn't a magic 'keep paying' switch; it's an attestation auditors test. We monitor each patient's accumulation, apply KX where documentation supports it, and flag cases approaching review territory before they get there.
Care delivered by PTAs bills with the CQ modifier (CO for OTAs) and pays at 85% under Medicare — with specific rules about when a visit becomes 'assistant-delivered' based on minute shares. Group versus one-on-one time, student participation, and supervision requirements add more layers. Getting the delivery attribution right protects both the revenue and the practice; payers reconcile staffing patterns against billing in PT audits. When visit caps and thresholds do produce denials, our CO-151 and CO-119 playbooks cover the recovery paths.
Specialties that generate the referrals behind most therapy plans of care.
Most therapy referrals originate post-operatively, where the global period governs what is separately payable.
Therapy is paired with interventional treatment, and both must document functional progress.
Neurological rehabilitation requires plans of care with different documentation standards to orthopedic therapy.
Gait and lower-limb rehabilitation is co-managed, particularly in diabetic patients.
We bill all of these in house. If your group spans several of them, multi-specialty billing keeps one team across every line — or see the full list of services.
Free tool: 8 Minute Rule Calculator — convert treatment minutes into billable units.
Free tool: Medicare Therapy Threshold & KX Calculator — see whether this patient has crossed the KX threshold.
Get a free billing audit and see how much more your PT clinic can collect.
Get Free Practice AuditFree resources: Denial Code Lookup | RVU Calculator | AR Days Calculator | Modifier 59 — distinct PT services & NCCI