Eligibility & Verification
Coverage checks before every visit.
Specialty Billing
Physical Therapy Medical Billing
PT billing lives and dies by timed units and plan-of-care rules. We apply the 8-minute rule and therapy modifiers correctly and manage caps so every treatment minute is billed accurately.
The Challenge
Physical Therapy billing, solved
We understand the billing complexities unique to physical therapy and build them into every claim.
- Timed units & the 8-minute rule
- Plan-of-care and cap management
- Therapy modifier accuracy
What we focus on
- Timed vs. untimed codes
- GP / KX therapy modifiers
- Plan-of-care documentation
Coding Focus
Physical Therapy code sets we work in
The CPT/HCPCS procedure families and ICD-10 diagnosis groups our certified coders handle for this specialty every day.
Common CPT / procedure codes
- 97110–97140Timed therapeutic exercise and manual therapy
- 97161–97164Physical therapy evaluation and re-evaluation tiers
- 97010–97028Supervised untimed physical modalities
- 97530–97542Therapeutic activities and functional training services
ICD-10 diagnosis focus
- M00–M99 musculoskeletal and joint dysfunction diagnoses
- Functional deficits following injury or surgery
- Z47.x aftercare following orthopedic procedures
- Gait, mobility, and balance impairment coding
Code references are shown as general identifiers for illustration. Actual code selection always follows current payer rules and your provider's documentation.
Clean Claims
Modifiers, denials & billing rules we manage
How our team keeps physical therapy claims compliant — the modifiers that matter, the denials we prevent, and the guidelines we follow.
Key modifiers
- GP
Signals that services were furnished under an established physical therapy plan of care.
- KX
Attests that continued therapy beyond the annual threshold remains medically necessary.
- 59
Separates distinct timed procedures such as manual therapy performed apart from therapeutic exercise.
- CQ
Indicates that a physical therapist assistant furnished part of the service.
Common denials & fixes
Incorrect timed-unit count under the 8-minute rule.
Total all timed minutes and apply the rule to assign the correct number of billable units.
Missing or unsigned plan of care or certification.
Obtain provider certification within required timeframes and re-certify on the mandated schedule.
Charges pass the therapy threshold without KX.
Append KX with documentation supporting the ongoing medical necessity of continued care.
Visits exceed authorization or lack progress evidence.
Track authorized visits and record measurable functional gains at each re-evaluation.
Billing guidelines
- Sum all timed-service minutes and apply the 8-minute rule before assigning units.
- Bill one evaluation tier per episode and support the complexity level selected.
- Keep the plan of care certified and re-certified within each payer's timeframe.
- Add KX once cumulative therapy charges pass the annual threshold, with justification on file.
End-to-End
What we handle for Physical Therapy
A complete revenue cycle service tailored to your specialty.
Specialty Coding
Certified, specialty-trained coders.
Charge Entry & Claims
Clean, accurate claim submission.
Payment Posting
ERA/EOB posting and reconciliation.
Denial & AR Management
Appeals and aggressive AR recovery.
Reporting & Analytics
Real-time KPIs and insights.
98%
Clean claim rate
30%
Average revenue lift
24/7
Operations coverage
HIPAA
Compliant processes
FAQ
Physical Therapy billing — FAQs
Yes — our certified coders are trained on specialty-specific rules, code sets, and payer policies, and we assign coders with experience in your specialty.
We work in your current practice management system and EHR, so your workflows and reporting stay intact while we handle the billing.
Through accurate specialty coding, front-end eligibility checks, clean claim submission, and relentless denial and AR follow-up — typically lifting first-pass acceptance and net collections.
Always. We use strict access controls, encryption, signed BAAs, and audit trails to protect patient data.
More Specialties
Other specialties we bill for
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