PM&R billing
Physical medicine and rehabilitation billing services
We handle billing for physiatrists and PM&R practices: office visits, EMG and nerve conduction studies, spasticity injections and inpatient rehabilitation rounds. 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.
- EMG and nerve conduction studies coded as a pair
- Botulinum toxin units, waste and guidance billed correctly
- Inpatient rehab and hospital visits tracked by facility
Why rehabilitation billing is different
Physiatry mixes diagnostics, procedures and hospital care
PM&R billing is different because a physiatrist may run electrodiagnostic tests, inject spastic muscles and round in an inpatient rehab facility in the same week. Each setting has its own codes and rules.
EMG and nerve conduction
Needle EMG done with nerve conduction studies is billed with add-on codes (95885 to 95887) alongside the NCS code, which is chosen by the number of studies (95907 to 95913). Payers expect the tests to match the clinical question.
Chemodenervation for spasticity
Botulinum toxin injections are coded by extremity or trunk (64642 to 64647), with EMG or electrical stimulation guidance billed as an add-on where allowed. Many payers require prior authorization.
Drug units and waste
Toxins are billed per unit with a HCPCS J-code. Medicare requires the JW modifier for discarded drug from a single-use vial and JZ when none was wasted. Units must match the injection record.
Inpatient rehab visits
Rehab physicians see patients often during an inpatient rehabilitation stay, and IRF coverage rules require frequent face-to-face visits. Hospital visit codes (99221 to 99233) are billed by date and facility.
Consultations by payer
Medicare does not pay consultation codes, so referrals are billed as new-patient or hospital visits. Some commercial payers still pay consult codes (99242 to 99245, 99252 to 99255). We bill each payer its way.
Orders for equipment and therapy
Physiatrists often order wheelchairs, braces and therapy. The order and face-to-face documentation affect whether the supplier or therapist gets paid, so we help make sure your notes support them.
Common codes
PM&R codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 95907–95913 | Nerve conduction studies, by number of studies | Count of studies matches the report; one code per session |
| 95885 / 95886 / 95887 | Needle EMG done with nerve conduction (add-ons) | Billed only with an NCS code; limited vs. complete extremity |
| 64642–64647 | Chemodenervation for spasticity by extremity or trunk | Prior authorization; per-extremity add-ons |
| 95873 / 95874 | Electrical stimulation or needle EMG guidance for chemodenervation | Add-on only; one guidance code per session |
| J0585 (and other toxin codes) | Botulinum toxin, per unit | Units match the record; JW or JZ modifier for Medicare |
| 20552 / 20553 | Trigger point injections (1–2 or 3+ muscles) | Once per session regardless of number of injections |
| 99221–99233 | Initial and subsequent hospital visits | Facility, date and level supported by the note |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
PM&R denials we stop before they happen
Most physiatry denials involve electrodiagnostics, injected drugs and hospital visits. We check each before the claim goes out.
- EMG add-on codes billed without a nerve conduction code
- NCS units that do not match the number of studies reported
- Toxin injections without a valid prior authorization
- Missing JW or JZ modifier, or units that do not match the vial record
- Consultation codes sent to payers that do not accept them
- Duplicate hospital visits when more than one provider rounds the same day
- Diagnosis codes that do not support medical necessity for the test
What we handle
Everything between the visit and the payment
Our core focus is behavioral health, and we bill physical medicine and rehabilitation with the same team, the same promises and CPB-certified billers on the team.
- Insurance eligibility, benefits and authorization checks before visits and procedures
- Charge entry and coding review of tests, injections, drug units and visits
- 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 physiatrists
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Pricing
Clear pricing for PM&R 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
How do you bill EMG and nerve conduction on the same day?
The nerve conduction study is billed by the number of studies performed, and the needle EMG is billed with an add-on code (95885, 95886 or 95887) that is only valid with an NCS code. We check both against the report.
Do you bill botulinum toxin for spasticity?
Yes. We bill the chemodenervation codes by extremity or trunk, the guidance add-on where allowed, and the drug per unit with the JW or JZ modifier Medicare requires. We confirm authorization is on file first.
Can you bill our inpatient rehab rounds?
Yes. We bill initial and subsequent hospital visits by facility and date, and check for overlapping visits by other providers in your group.
Does Medicare pay for PM&R consultations?
No. Medicare stopped paying consultation codes, so those visits are billed as new-patient office or hospital visits. Some commercial payers still accept consult codes, and we bill each payer by its rules.
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.
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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