Physical therapy billing, handled with care
Where physical therapy billing gets difficult
The issues we see most often, and the ones that quietly cost practices the most.
Counting timed units
Medicare and commercial plans may count timed minutes differently, and the method affects how many units can be billed.
Plan of care certification
Unsigned or expired plans of care can make otherwise well-documented visits unbillable to Medicare.
Visit limits and authorizations
Commercial plans often cap therapy visits or authorize a fixed number at a time, requiring close tracking.
Assistant services
Services provided by physical therapist assistants may require specific modifiers and can be paid differently.
How we handle them
Minute-based unit review
We calculate units from documented treatment minutes using the method each payer requires.
Certification tracking
We monitor plan of care signatures and recertification dates and remind your team before they lapse.
Visit and threshold monitoring
We track authorized visits and Medicare therapy amounts so patients and staff know where they stand.
Modifier setup by provider
Discipline and assistant modifiers are set up in your system so they are applied consistently.
Coding notes
General guidance only. Code sets update every year and payer policies vary, so we check current rules on every claim.
- Timed codes and the 8-minute rule
- Codes such as 97110, 97112, 97140 and 97530 are timed in 15-minute units. Medicare totals timed minutes and requires at least 8 minutes for one unit. Some commercial plans count each code separately instead.
- GP and assistant modifiers
- Outpatient physical therapy services are reported with modifier GP. Medicare also requires the CQ modifier when a PTA furnishes all or part of a service, which may reduce payment.
- KX modifier at the threshold
- When a Medicare patient’s therapy spending exceeds the annual threshold, the KX modifier attests that continued care is medically necessary and documented. The amount is updated each year.
- Plan of care certification
- For Medicare, the plan of care should be certified by a physician or qualified practitioner, generally within 30 days of the initial evaluation, and recertified at least every 90 days or when the plan changes significantly.
Physical therapy billing questions
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