Physical therapy billing
Physical therapy billing services
We handle billing for outpatient physical therapy clinics and private practice PTs: eligibility and visit limits, timed-code units, therapy modifiers, claims, payments and denials. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Timed units checked against the 8-minute rule
- GP, KX and CQ modifiers applied by payer
- Plan-of-care, visit and authorization tracking
Why physical therapy billing is different
Therapy claims are billed in minutes, units and modifiers
PT billing is different because most treatment codes are timed, and each payer counts units, visits and documentation its own way. One miscount can deny or cut a whole claim.
The 8-minute rule
Medicare converts total timed treatment minutes into units using the 8-minute rule. Many commercial payers count each timed code on its own instead. We check units against documented minutes and the payer’s method before the claim goes out.
Therapy threshold and KX
Once a Medicare patient’s yearly therapy charges pass the threshold amount CMS sets each year, claims need the KX modifier to confirm the care is medically necessary and documented. We track each patient’s running total so the modifier is added at the right visit.
GP and CQ modifiers
Medicare and many other payers require the GP modifier on outpatient PT services. Services furnished in whole or in part by a physical therapist assistant also need the CQ modifier, which Medicare pays at a reduced rate.
Plan-of-care certification
Medicare requires a physician or qualified practitioner to certify the plan of care and recertify it at least every 90 days, with progress reports along the way. Missing signatures are a common reason therapy claims fail review.
Visit limits and authorizations
Commercial and Medicare Advantage plans often cap visits or approve them in blocks. We check benefits before the first visit and flag when an authorization is close to running out.
Evaluation codes and bundling
Evaluations are untimed and billed by complexity (97161 to 97163), while some pairs of treatment codes need a modifier to be paid together. We apply NCCI edits before submission, not after a denial.
Common codes
Physical therapy codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 97161 / 97162 / 97163 | PT evaluation: low, moderate or high complexity | Complexity supported by the documentation; untimed, one unit |
| 97164 | PT re-evaluation | A real change in condition or plan, not routine progress notes |
| 97110 | Therapeutic exercise (timed) | Units match documented minutes and the payer’s counting method |
| 97112 | Neuromuscular re-education (timed) | Documentation shows balance, coordination or proprioception goals |
| 97140 | Manual therapy techniques (timed) | Modifier 59 or X{EPSU} only when a bundling edit truly allows it |
| 97530 | Therapeutic activities (timed) | Functional, dynamic activities described in the note |
| 97116 | Gait training (timed) | Separate time from other timed codes in the same visit |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Therapy denials we stop before they happen
Most PT denials come from a short list of avoidable problems. We check for each one during charge review.
- Units billed that the documented minutes do not support
- Missing GP modifier, or missing CQ modifier on assistant services
- No KX modifier after the Medicare therapy threshold is reached
- Plan of care not certified or recertified on time
- Visits beyond the authorized number or dates
- Missing referral or prescription where the payer or state requires one
- Bundled code pairs billed without a supported modifier
What we handle
Everything between the visit and the payment
Our core focus is behavioral health, and we bill physical therapy with the same team, the same promises and CPB-certified billers on the team.
- Insurance eligibility, benefits and visit-limit checks before care starts
- Charge entry and coding review of timed units and modifiers
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Credentialing and payer enrollment for new therapists
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Pricing
Clear pricing for PT practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free with billing.
Common questions
Do you bill workers’ compensation?
Yes. We bill workers’ compensation carriers directly, separate from health insurance. We set up each injury case with the carrier, claim number, adjuster and employer details, and follow the state’s fee schedule, forms and documentation rules.
Do you apply the 8-minute rule to every payer?
No. We apply it where the payer uses it, which includes Medicare and plans that follow Medicare rules. Some commercial payers count each timed code separately, so we bill units by each payer’s method.
How do you know when to add the KX modifier?
We track each Medicare patient’s therapy charges for the year. When the total reaches the threshold CMS sets for that year, we add KX to claims where the documentation supports continued medically necessary care.
Do you bill services provided by PTAs?
Yes. We add the CQ modifier where required and make sure supervision rules for your setting and payer are met. Medicare pays assistant services at a reduced rate, so we flag this in your reports.
Can you track authorizations and visit limits?
Yes. We check benefits before the first visit, record approved visits and dates, and alert your team before an authorization runs out so you can request more.
Do you call our patients about balances?
No. Our billing team does not talk to patients. We send statements and track balances, and patient calls go to your front desk or to an optional RevenueCTRL virtual assistant.
Which EHRs do you work in?
We work inside the system you already use, including Tebra (Kareo), AdvancedMD, athenahealth, DrChrono, eClinicalWorks, Office Ally and others.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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