Expert Physical Therapy Billing Services
Physical therapy billing has rules that general medical billing doesn’t: timed codes, unit calculations, discipline modifiers, therapy thresholds, and plan-of-care documentation. Medix Revenue Group handles the full billing cycle for PT practices so your team can spend its time on patients instead of payer portals.
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HIPAA
Compliant -
Certified Coders
& Billers -
Specialty-Focused
RCM
Why Physical Therapy Medical Billing Is More Complex Than Other Specialties
A claim that would pass for a family practice can be denied or underpaid in a PT clinic. The most common reasons:
- Time-based billing. Many PT codes are billed in 15-minute units, and unit counts must match documented minutes.
- Modifiers. Therapy services typically require the GP modifier, and other modifiers (KX, CQ, 59 or X-modifiers) apply in specific situations.
- Medicare therapy rules. Outpatient therapy is subject to annual threshold amounts, medical-necessity documentation, and a certified plan of care.
- Payer variation. Visit limits, authorization requirements, and bundling edits differ widely across commercial plans, Medicaid, and workers' compensation.
- Documentation. Evaluations, progress reports, and recertifications must support what was billed.
Our team works through these requirements on every claim.
Physical Therapy Billing and RCM Services We Provide
At Medix Revenue Group, we specialize in physical therapy billing, helping providers avoid costly in-house errors and claim denials. Our trained billers and coders handle the complexities of insurance reimbursements, so you can focus on patient care.
We offer end-to-end customized solutions to healthcare providers. They are the following:
Insurance Eligibility and Benefits Verification
Before the first visit, we confirm coverage, deductibles, copays or coinsurance, visit limits, and whether authorization is required, so your front desk can set patient expectations up front.
Prior Authorization Support
Where payers require authorization for evaluations or ongoing visits, we help submit requests and track approvals and remaining visits.
Medical Coding Review
We review CPT and ICD-10 coding against your documentation, including timed-unit calculations, modifier use, and common code pairings that trigger bundling edits.
Charge Entry and Claim Submission
Clean, timely claim submission with scrubbing for the errors that most often cause PT rejections: missing modifiers, unit mismatches, and demographic or eligibility errors.
Payment Posting
Electronic and manual payment posting with review of each remittance for underpayments and contractual adjustments.
Denial Management and Appeals
We track denials by reason, correct and resubmit what can be fixed, and appeal what should be appealed. We also report denial patterns back to your team so root causes can be addressed.
Accounts Receivable Follow-Up
Structured follow-up on unpaid and aging claims, prioritized by balance and payer timely-filing limits.
Credentialing and Payer Enrollment
We prepare and submit applications for individual PTs and group practices, and track revalidation dates.
Reporting
Every month you get a report covering collections, clean claim rate, denial reasons, days in A/R, and payer performance, followed by a call to walk through it. You always know where your revenue stands and what needs attention.
Common Physical Therapy CPT Codes We Bill
| CPT Code | Description | Billing Note |
|---|---|---|
| 97161 / 97162 / 97163 | PT evaluation (low / moderate / high complexity) | Untimed; complexity must be supported by documentation. GP modifier applies. |
| 97164 | PT re-evaluation | Untimed; payer criteria for when it's appropriate vary. Document a change in status or plan of care. |
| 97110 | Therapeutic exercise | Timed, per 15 minutes; units must match documented minutes (8-minute rule). |
| 97112 | Neuromuscular re-education | Timed, per 15 minutes; document the skilled neuromuscular purpose. |
| 97116 | Gait training | Timed, per 15 minutes; document the gait deficit being treated. |
| 97140 | Manual therapy techniques | Timed; NCCI edits may apply with other codes. Use 59/X modifiers only when documentation shows a separate service. |
| 97530 | Therapeutic activities | Timed, per 15 minutes; needs direct one-on-one time. Code-pair edits with 97140 are common. |
| 97535 | Self-care / home management training | Timed, per 15 minutes; tie instruction to functional goals. |
| 97035 | Ultrasound | Timed, per 15 minutes. |
| 97032 | Electrical stimulation (attended) | Timed, per 15 minutes; requires direct one-on-one contact. |
| G0283 / 97014 | Electrical stimulation (unattended) | G0283 for Medicare, 97014 for many commercial payers. Confirm which each payer accepts. |
| 20560 / 20561 | Dry needling | Coverage varies widely by payer and state. |
The 8-Minute Rule for PT Billing: Units and Minutes Explained
For Medicare, timed codes are billed based on the total minutes of all timed services in a visit, not each code on its own. A unit requires at least 8 minutes. In general:
| Total Timed Minutes | Units Billable |
|---|---|
| 8 to 22 | 1 |
| 23 to 37 | 2 |
| 38 to 52 | 3 |
| 53 to 67 | 4 |
| 68 to 82 | 5 |
| 83 to 97 | 6 |
How units are then assigned across individual codes depends on the minutes spent on each. Some commercial payers use different methods, so we confirm each payer’s rule rather than assuming.
Medicare Therapy Billing Requirements: KX Modifier, CQ Modifier, and Plan of Care
- Therapy threshold (KX modifier). Medicare sets an annual threshold amount. Above it, the KX modifier and documentation of medical necessity are required. The amount is updated each year, so we use the current CMS figure.
- CQ modifier. Services furnished in whole or in part by a physical therapist assistant require the CQ modifier and are paid at a reduced rate under Medicare.
- Plan of care and recertification. Medicare requires a certified plan of care, with recertification when the plan or duration changes.
- Progress reports. Required at regular intervals under Medicare rules.
- Multiple procedure payment reduction (MPPR). Applies to certain therapy services billed on the same day.
- Authorizations and visit limits. Tracked per patient for commercial and Medicaid plans.
Payer rules change. We verify requirements against current CMS and payer publications before billing.
Top Reasons PT Claims Get Denied and How to Prevent Them
| Denial Reason | How We Address It |
|---|---|
| Missing or incorrect modifier (GP, KX, CQ, 59) | Pre-submission claim review against modifier rules |
| Units don't match documented time | Unit calculation check before submission |
| No authorization or visits exhausted | Verification at scheduling; visit tracking |
| Medical necessity not supported | Flag documentation gaps for your clinicians |
| Bundling / NCCI edits | Code-pair review; modifier use only where documentation supports it |
| Eligibility or coverage issues | Verification before the first visit and on a recurring basis |
| Timely filing exceeded | A/R work queue prioritized by filing deadline |
PT Billing Services That Work With Your Existing Software
We work inside your current practice management or EHR system rather than requiring you to switch. Systems we have experience with include:
Billing for Outpatient, Pediatric, Pelvic Floor, and Multi-Location PT Practices
- Outpatient orthopedic and sports PT clinics
- Pediatric PT practices
- Pelvic floor and women's health PT
- Multi-location PT groups
- Practices with workers' compensation and auto/personal injury cases
Nationwide Physical Therapy Billing for Practices in Every State
Billing rules for physical therapy don’t stop at the state line. Payer mix, Medicaid programs, workers’ compensation fee schedules, and direct access laws all vary by state, and each one affects how claims are coded, submitted, and paid. We bill for PT practices across the United States and stay current on the payers and requirements that apply where your clinic operates.
Switching Physical Therapy Billing Companies Without Disrupting Your Practice
1. Free consultation
We learn about your practice, payers, and current billing challenges.
2. Billing review
We look at your recent claims, denials, and A/R to identify what needs attention first.
3. Setup
We get access to your system and set up payer, clearinghouse, and reporting workflows.
4. Go-live
We begin billing and follow-up, with a named point of contact for your practice.
5. Ongoing reporting
Regular performance reviews and recommendations.
How Much Does Physical Therapy Billing Cost?
We charge a percentage of what your practice collects, typically 3% to 8% depending on your claim volume, payer mix, and the services you include. If you don’t get paid, we don’t either, so our incentives stay aligned with yours.
- No hidden fees
- No long-term contracts
After a short review of your practice, we’ll give you a written quote.
HIPAA-Compliant Physical Therapy Billing Company
We handle protected health information (PHI) under HIPAA and sign a Business Associate Agreement (BAA) with every client before any work begins. Access to patient data is limited to team members who need it for billing, and all staff are trained on HIPAA privacy and security requirements.
We work through secure, encrypted systems, and we follow the minimum-necessary standard, which means we only access the information required to bill and follow up on claims.
Contact Us for Expert Physical Therapy Billing Solutions
Ready to boost your revenue and reduce claim denials? Our specialized billing team is here to support your physical therapy practice with end-to-end solutions, so you can focus on delivering exceptional patient care while we handle the financials.
Frequently Asked Questions (FAQs)
How much does physical therapy billing cost?
We charge a percentage of what your practice collects, typically 3% to 8% depending on claim volume, payer mix, and the services included. There are no hidden fees and no long-term contracts. We’ll give you a written quote after reviewing your practice.
What is the 8-minute rule in PT billing?
It’s the Medicare method for converting total timed treatment minutes into billable 15-minute units. You need at least 8 minutes of timed service to bill one unit, and units are based on the combined minutes of all timed codes in the visit. Some commercial payers use different methods, so we confirm each payer’s rule.
What modifiers are used in physical therapy billing?
GP is the most common, since it identifies services delivered under a physical therapy plan of care. Others apply in specific cases: KX when Medicare’s therapy threshold is exceeded and services are medically necessary, CQ for services furnished in whole or in part by a physical therapist assistant, and 59 or X-modifiers for distinct services that would otherwise bundle.
Can you work inside our EHR or billing software?
In most cases, yes. We work within your current system rather than asking you to switch. Tell us which one you use and we’ll confirm during your consultation.
Is outsourcing worth it for a small PT practice?
It can be, particularly if your front desk is spending hours on claims and follow-up or your A/R is aging. Because we charge a percentage of collections, you don’t carry the fixed cost of a full-time biller. We’re happy to look at your numbers and tell you honestly whether it makes sense.
Can we switch billing companies without disrupting our cash flow?
A transition does take planning, but claims should keep moving while we get set up. We coordinate the handoff, including claims already submitted and open A/R, so nothing falls through.
Do you handle credentialing for new physical therapists and new locations?
Yes. We prepare and submit payer enrollment applications, track follow-up, and monitor revalidation dates. Approval timelines are set by each payer, so we can’t control how long they take.
How do you handle denied claims?
We review each denial by reason, correct and resubmit what can be fixed, and appeal what should be appealed. We also report recurring denial causes, such as modifier errors or unit mismatches, so they get fixed at the source.
Is our patient data protected?
Yes. We handle protected health information under HIPAA and sign a Business Associate Agreement with every client before work begins. Access is limited to team members who need it for billing.