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Physical Therapy billing

Physical Therapy Billing Services

The 8-minute rule, evaluation complexity, plan-of-care certifications and the KX threshold make PT billing deceptively complex. Specialist billers keep every unit paid.

  • Timed codes billed correctly under the 8-minute rule
  • Plans of care, recertifications and visit limits tracked
  • Medicare GP, KX and CQ modifiers applied correctly

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97%
Clean-claim rate target
15%
Revenue often lost on unit errors
< 30
Days in A/R goal
Overview

How physical therapy billing works

Most physical therapy services are timed codes billed in 15-minute units. For Medicare, the total timed minutes in a visit determine the number of units under the 8-minute rule, and minutes must be assigned to codes correctly. Commercial payers may follow different rules, so billing must adapt by payer.

Evaluations are coded by complexity (low, moderate or high), plans of care require physician certification and periodic recertification, and Medicare applies an annual therapy threshold beyond which the KX modifier and medical-necessity documentation are required. Services provided by PT assistants carry their own modifier and payment reduction.

Clinics also manage visit limits, authorizations and high patient copays. A physical therapy billing partner tracks authorizations and certifications, calculates units from documented minutes, and works denials before they age, so therapists can focus on outcomes.

Why it's hard

Common physical therapy billing challenges

01

8-minute rule calculations

Units must follow total timed minutes; miscounting either loses revenue or creates audit risk.

02

Plan of care certifications

Unsigned or expired plans of care lead to denied visits.

03

KX threshold tracking

Medicare requires KX and documentation once yearly therapy spending passes the threshold.

04

Visit limits and authorizations

Commercial plans cap visits and require progress reports for more.

05

PTA services

Services by assistants need CQ modifiers and are paid at reduced rates by Medicare.

06

NCCI edits between codes

Some therapy code pairs need modifier 59 or X{EPSU} when performed separately.

What's included

What a physical therapy billing partner should handle

  • Benefits, visit limits and authorization checks
  • Evaluation and re-evaluation coding
  • Timed-unit calculation under the 8-minute rule
  • Plan of care and recertification tracking
  • GP, KX, CQ and 59/X modifier management
  • Workers’ comp and auto injury billing
  • Claim submission and payment posting
  • Denial management and appeals
  • Patient copay and statement management
  • Therapist productivity and visit reports
Coding focus

Key codes in physical therapy billing

Code(s)What it covers
97161–97163Physical therapy evaluation, low, moderate and high complexity.
97164Physical therapy re-evaluation.
97110Therapeutic exercise, each 15 minutes.
97112Neuromuscular re-education, each 15 minutes.
97140Manual therapy techniques, each 15 minutes.
97530Therapeutic activities, each 15 minutes.
GP / KX / CQPT plan-of-care modifier, therapy threshold exception, and PTA-delivered service.

Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.

Document minutes and progress

Record total timed and untimed minutes for every visit, link treatment to goals in the plan of care, and show measurable progress. This supports units billed and continued medical necessity.

How it works

Find the right billing partner in four steps

1

Share your goals

Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.

2

Get a free audit

We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.

3

Compare vetted companies

Shortlist billers with proven physical therapy experience, transparent pricing and verified client reviews.

4

Onboard with confidence

Sign a BAA, connect your EHR and clearinghouse, and track clean-claim rate, days in A/R and collections from month one.

Compare

Top-rated medical billing companies

Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their physical therapy experience.

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5.0 5 reviews

Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...

Atlanta, Georgia
Founded 2015
Claims ProcessingDenial ManagementCredentialing (Payer & License)
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GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: •  Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. •  Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. •  Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. •  Financial Solutions - Data-driven insights and financial reporting to optimize practice...

Las Vegas, Nevada
Founded 2003
Claims ProcessingDenial ManagementRevenue Cycle Management
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Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...

Corona, California
Founded 1994
Claims ProcessingDenial ManagementRevenue Cycle Management
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Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...

Chandler, Arizona
Founded 2007
Claims ProcessingDenial ManagementRevenue Cycle Management
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Pricing

How much does physical therapy billing cost?

Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.

Percentage of collections
5% - 8%

Most common. You pay only on money collected.

Per claim
$4 - $10

Predictable for high-volume, low-complexity claims.

Hourly / FTE
$12 - $35/hr

Dedicated billers working inside your systems.

Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.

FAQ

Physical Therapy billing FAQs

A Medicare rule that determines billable units for timed codes: a unit can be billed when at least 8 minutes are provided, based on total timed minutes for the visit.

When a Medicare patient’s annual therapy costs exceed the threshold and the services remain medically necessary and documented.

Yes, Medicare requires certification of the plan of care, usually within 30 days, and recertification at set intervals.

With the CQ modifier for Medicare when an assistant provides services in whole or in significant part; payment is reduced.

Yes, billers monitor authorized visits and request extensions with progress notes before limits are reached.

Usually 5% to 8% of collections, or a per-visit fee.

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