Physical Therapy Billing

Physical Therapy Billing Services

PT billing services built around the rules that trip up therapy clinics: the 8-minute rule, timed and untimed codes, the GP modifier, the Medicare KX threshold, plan-of-care certifications and visit limits. We bill clean, chase every denial and keep your clinic’s cash flow steady.

Medical billing and claims paperwork on an office desk

The Problem

Physical Therapy Billing Has More Rules Than Most

Billing physical therapy is unit-based and heavily regulated. Medicare’s 8-minute rule, plan-of-care certifications, progress note timing, the KX modifier threshold and payer visit limits all decide whether a claim pays.

Small errors in units or modifiers repeat across hundreds of visits, which is why PT clinics often lose more to billing mistakes than they realise.

01

Unit miscalculations.

Wrong application of the 8-minute rule under- or over-bills timed codes.

02

Missing modifiers.

GP, KX, 59 and X modifiers missing or misused lead to denials.

03

Plan-of-care gaps.

Uncertified plans of care and late progress notes stop Medicare payment.

04

Visit and authorization limits.

Visits beyond authorized counts are denied.

What We Do

Our PT Billing Services

01

Eligibility and Visit Limits

Benefits, visit limits and authorization requirements verified before evaluation.

02

Timed Code Units

Units calculated correctly for CPT 97110, 97140, 97530 and other timed codes.

03

Modifiers and KX Threshold

GP, KX and 59 applied correctly and the therapy threshold tracked per patient.

04

Plan-of-Care Tracking

Certification and recertification dates and progress notes tracked.

05

Claim Submission

Clean claims submitted daily to Medicare, Medicaid and commercial payers.

06

PIP and Workers’ Comp

Auto injury and workers’ compensation claims billed to the right carrier.

07

Denials and Appeals

Every denial worked and appealed.

08

Clinic Reporting

Visits, collections per visit, denials and days in A/R.

The Process

How We Take Over Your PT Billing

01

Billing Review

We review units, modifiers and denials from recent claims.

02

Setup

Access to your PT EMR (WebPT, Prompt, Raintree and others).

03

Front-End Checks

Eligibility, visit limits and authorizations verified.

04

Daily Billing

Claims coded and submitted daily.

05

Follow-Up

Denials and unpaid claims worked weekly.

06

Monthly Review

KPIs and plan-of-care compliance reviewed.

FAQ

Physical Therapy Billing Questions

Medicare’s 8-minute rule says a timed therapy code can be billed for one unit if at least 8 minutes of that service were provided. Total timed minutes are added up and converted to units: 8 to 22 minutes is one unit, 23 to 37 is two, 38 to 52 is three, and so on.

There is no fixed unit cap per visit; units depend on total timed minutes under the 8-minute rule, plus untimed codes billed once. Payers may apply their own limits, and Medicare applies medically unlikely edits per code.

The KX modifier tells Medicare that therapy above the annual threshold is medically necessary and documented. Once a patient’s therapy costs pass the threshold for the year, claims need KX to be paid.

Most PT billing companies charge 4% to 8% of collections.

Yes, including Florida PIP auto claims and workers’ compensation.

We work in common PT EMRs and practice management systems such as WebPT, Prompt, Raintree and others.

Yes. Medical billing for physical therapy relies on timed units, the 8-minute rule, GP and KX modifiers and plan-of-care rules.

Latest Insights

Related Reading

Stop Losing Revenue to PT Billing Rules

Book a free PT billing review and we will check your units, modifiers and denials on a sample of recent claims.