Physical Therapy Billing Articles & Guides

Physical therapy billing requires mastery of rules and regulations that are distinct from most other medical specialties. The CMS 8-minute rule governs how therapists calculate billable units for timed CPT codes, and misapplication of this rule is one of the most common sources of revenue loss in PT practices. Understanding the difference between timed codes (such as therapeutic exercise 97110, manual therapy 97140, and neuromuscular re-education 97112) and untimed codes (like hot/cold packs 97010 and electrical stimulation 97014) is critical for accurate billing and audit protection.

Therapy cap management adds further complexity to physical therapy revenue cycles. While the former hard caps have been replaced by the Medicare threshold system, practices must still track spending thresholds and apply the KX modifier to certify medical necessity when services exceed the annual limit. Failure to append KX when required, or appending it without adequate documentation, exposes practices to targeted medical review and potential recoupment of payments. Evaluation code selection under the revised framework (97161, 97162, 97163) based on complexity rather than time also requires careful clinical documentation.

Group therapy versus individual therapy billing, correct use of the GP modifier for Medicare claims, student supervision rules, and maintenance therapy coverage under the Jimmo v. Sebelius settlement all present additional challenges that PT practice owners must navigate daily. Medtransic delivers specialized physical therapy billing services designed to optimize unit counting, ensure modifier compliance, and protect practices from costly audit findings. Our billing professionals stay current with CMS transmittals and MAC-specific policies, ensuring your practice captures every legitimate reimbursement dollar while remaining fully compliant with federal and commercial payer requirements.

Physical Therapy Billing Articles

• Physical Therapy Medical Billing Company: The 8-Minute Rule, Therapy Caps, and Everything Else Your Billing Partner Needs to Get Right - Physical therapy billing operates under rules that don't exist in any other medical specialty. The 8-minute rule dictates how many units you can bill. Timed and untimed codes follow completely different logic. Medicare's therapy cap threshold requires a KX modifier or your claims get auto-denied. And your evaluation codes (97161–97163) must match the complexity documented in the chart. A billing company that doesn't live in these rules every day will cost you more than they save. This guide breaks down what makes PT billing different and exactly what to demand from any company that wants to handle it. (14 min read)