ClaimCarePro
Outpatient PT and rehab billing, nationwide

Physical Therapy Billing Services

Physical therapy billing services cover benefit verification, timed-code unit calculation, modifiers, plan-of-care tracking, claim submission and denial work for outpatient PT clinics and rehab groups. ClaimCarePro provides physical therapy billing services with payer credentialing included.

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~95%
First-pass clean claim (established accounts)
6%
of collections — ongoing billing fee
24–48 h
From signed note to submitted claim
30+ yrs
Combined billing experience

The rule every PT claim is paid by

The 8-minute rule, applied correctly to each payer

Medicare pays timed codes on total treatment minutes. Many commercial plans count each code separately. We apply the method each payer actually uses, so units are neither inflated nor given away.

1 unit

8–22 min

2 units

23–37 min

3 units

38–52 min

4 units

53–67 min

Total timed minutes across all timed codes in the visit, Medicare method. Untimed codes are billed once regardless of minutes. The annual KX threshold dollar amount is published by CMS each January; we update it the day it changes.

PT billing cheat sheet

The codes and modifiers we bill every day

This is the working set for an outpatient PT claim. Which combinations pay, and at what rate, differs by payer — that is the work.

Evaluations

97161 · 97162 · 97163 (low / moderate / high complexity) · 97164 re-evaluation

Timed treatment codes (15-min units)

97110 therapeutic exercise · 97112 neuromuscular re-education · 97140 manual therapy · 97530 therapeutic activities · 97535 self-care training · 97116 gait training

Untimed codes (once per visit)

97012 mechanical traction · 97014 unattended e-stim (G0283 for Medicare) · 97035 ultrasound · 97010 hot/cold packs (bundled by most payers)

Modifiers

GP plan of care · KX above the annual threshold · CQ for PTA-delivered services · 59 / X-modifiers only for genuinely distinct services

What our physical therapy billing services include

Timed-code unit calculation

Units for 97110, 97112, 97140, 97530 and 97535 computed from total timed minutes under the 8-minute rule, with untimed codes (97012, 97014 / G0283, 97035) billed once per session, so no unit is over- or under-billed.

Evaluations and plan-of-care compliance

Complexity-tiered evaluations (97161 / 97162 / 97163) and re-evaluations (97164) coded to the documentation; Medicare plan-of-care certification and progress-note cadence tracked so claims are not denied on paperwork.

Modifiers: GP, KX, CQ and 59

GP on every PT plan-of-care service, KX once the annual threshold is crossed with medical necessity documented, CQ when a PTA delivers the service, and 59 only where NCCI genuinely allows a distinct service.

Authorizations and visit limits

Commercial visit caps, Medicaid prior authorizations and workers' compensation approvals tracked per patient, with remaining visits visible to the front desk before the next appointment is booked.

Denials, MPPR and underpayments

Multiple-procedure payment reductions reconciled line by line, bundling denials appealed with the note, and workers' comp and auto-injury fee-schedule underpayments pursued.

Reporting by therapist and payer

Units billed vs paid, average reimbursement per visit, denial reasons and days in A/R by therapist, location and payer.

Where PT revenue leaks — and how we stop it

The 8-minute rule

Medicare pays timed codes by total treatment minutes: 8–22 minutes is one unit, 23–37 two, 38–52 three, 53–67 four. Commercial payers may count each code separately instead. Billing the wrong method on the wrong payer is the most common PT overpayment and underpayment at once.

KX threshold and medical necessity

Once a patient's PT and speech-therapy spend passes the annual threshold CMS publishes each January, every claim needs the KX modifier and documentation that continued care is medically necessary. Claims without it deny; claims with it and thin notes get audited.

PTA services and the CQ modifier

Services furnished in whole or in part by a physical therapist assistant are billed with CQ and paid at a reduced rate by Medicare. Missing the modifier is a compliance problem; applying it when the PT did the work gives revenue away.

NCCI edits and the 59 modifier

97140 with 97530, or an evaluation with treatment on the same day, hit bundling edits. Modifier 59 unlocks payment only when the services were distinct and the note proves it.

Plan-of-care certification

Medicare requires the plan of care to be certified by the referring physician within 30 days and recertified when it changes or expires. A signature that never came back turns a month of visits into a write-off.

Workers' comp and auto-injury schedules

Workers' compensation and personal-injury payers use their own fee schedules and authorization rules. In Florida, PIP claims are priced against the §627.736 schedule and a $10,000 benefit that exhausts fast.

Built for rehab

Who we serve

From a single-therapist clinic to a multi-site, multi-discipline group — one team, one report.

Outpatient PT clinics

Single-site and multi-location private practices on Medicare, commercial and Medicaid.

Multi-discipline rehab groups

PT, OT and speech under one account with GP / GO / GN lines and per-discipline thresholds.

Chiro + PT integrated clinics

CMT and therapy codes on the same day, billed to the right payer rules without bundling denials.

Workers' compensation caseloads

State fee schedules, carrier authorizations and the paperwork that keeps comp claims paying.

Auto-injury and PIP practices

Florida §627.736 pricing, benefit exhaustion tracking and letter-of-protection balances.

Cash-plus-insurance models

Wellness and cash programs kept separate from insured care with compliant fee policies.

Billing and credentialing together

A new therapist should bill from week one

Medicare enrollment, commercial panels and Medicaid applications are handled by the same team that bills the visits — so nothing is delivered before the effective date without a plan for it.

  • Published pricing — flat per-provider fees on our credentialing services page; no quotes, no surprises.
  • Weekly payer follow-up — every application chased until the effective date is in writing.
  • Claims held, not lost — visits before the effective date are held and released the day enrollment lands.

Why PT clinics choose ClaimCarePro

Clean claims on established accounts

Established accounts run a ~95% first-pass clean claim rate — units, modifiers and certifications checked before submission.

Fees on what is collected

Ongoing billing is 6% of collections ($1,000/month minimum, month-to-month). No setup fee, nothing owed on claims that do not pay.

Front desk sees remaining visits

Authorizations, visit caps and threshold status are visible before scheduling, so care never outruns coverage.

A bench that scales with the clinic

A large bench of experienced part-time billers scaled onto your account as you add therapists or locations, plus AI automation that streamlines verification and posting.

How we take over your physical therapy billing

  1. 1

    Coding and A/R audit

    We review 90 days of claims for unit-count errors, missing modifiers, expired plans of care and unworked denials, and tell you what is still recoverable.

  2. 2

    Recover the aged A/R

    Denied and underpaid claims — bundling, MPPR, workers' comp, PIP — are appealed and re-priced on a 15% contingency. No recovery, no fee.

  3. 3

    Verification and authorization setup

    Benefits, visit limits, authorization requirements and threshold tracking configured per payer; the front desk gets a remaining-visits view.

  4. 4

    Daily coding and submission

    Timed minutes to units, modifiers and plan-of-care status checked on every visit; claims out within 24–48 hours of the signed note.

  5. 5

    Posting, follow-up and reporting

    ERAs posted, denials worked within days, patient balances collected, and a monthly report by therapist, location and payer.

Physical therapy billing services: questions buyers ask

What are physical therapy billing services?
Physical therapy billing services are the benefit verification, CPT coding, unit calculation, modifier application, claim submission, payment posting, denial management and patient statement work done for outpatient PT clinics, hospital-affiliated therapy departments and multi-discipline rehab groups. ClaimCarePro provides physical therapy billing services as one outsourced team that also handles payer credentialing.
What is the medical billing code for physical therapy?
There is no single code. Evaluations are 97161, 97162 and 97163 by complexity, with 97164 for re-evaluation. The most common timed treatment codes are 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97140 (manual therapy), 97530 (therapeutic activities) and 97535 (self-care training). Common untimed codes are 97012 (mechanical traction), 97014 (unattended electrical stimulation, billed as G0283 to Medicare) and 97035 (ultrasound). Every PT plan-of-care service carries the GP modifier.
What is the 8-minute rule in physical therapy billing?
Under Medicare's 8-minute rule, timed codes are paid in 15-minute units based on the total timed minutes in the visit: 8–22 minutes is one unit, 23–37 is two, 38–52 is three and 53–67 is four. Many commercial payers instead follow the AMA method, which counts each code's minutes separately. Billing the wrong method on the wrong payer is the most common PT unit error.
How much do physical therapy billing services cost?
ClaimCarePro charges 6% of collections for ongoing physical therapy billing services ($1,000/month minimum, month-to-month, no setup fee). Recovery of aged or denied claims is a 15% contingency — nothing collected, nothing owed. Credentialing is a published flat $250 per payer application ($1,750 new-practice bundle).
What are the KX, GP and CQ modifiers?
GP identifies a service delivered under a physical therapy plan of care and goes on every PT claim line. KX is added once a Medicare patient's combined PT and speech-therapy spend passes the annual threshold CMS publishes each January; it attests that continued care is medically necessary and must be backed by the note. CQ marks a service furnished in whole or in part by a physical therapist assistant, which Medicare pays at a reduced rate.
Do you bill workers' compensation and auto-injury (PIP) physical therapy?
Yes. Workers' compensation claims are billed to each state's fee schedule with the carrier's authorization on file. In Florida, auto-injury visits are billed under the PIP statute (§627.736) at the statutory schedule, with the $10,000 benefit tracked per patient so treatment is not delivered past exhaustion. Our Florida PIP billing page covers the coordination waterfall from PIP to MedPay to health insurance to letters of protection.
How do you handle plan-of-care certification and progress notes?
We track the referring physician's certification of the plan of care and chase the signature before the 30-day window closes, flag recertification dates, and confirm progress notes are documented at the cadence Medicare and the commercial payer require. Claims are held, not lost, if a signature is outstanding.
Can you bill occupational and speech therapy too?
Yes. Multi-discipline rehab groups are billed under one account with the correct discipline modifier on each line — GP for physical therapy, GO for occupational therapy and GN for speech-language pathology — and the thresholds and authorizations tracked per discipline.

Related resources

Florida PIP billing services

The §627.736 fee schedule, the $10,000 benefit and the PIP → MedPay → health → LOP waterfall.

Credentialing services

Published per-provider pricing for Medicare, Medicaid and commercial enrollment.

Chiropractic billing services

For integrated chiro + PT clinics: CMT, therapies on the same day and Medicare maintenance-care rules.

Find the units you are leaving on the table

Send us 90 days of claims and we will show you the unit-count errors, the expired certifications and the denials that can still be appealed.

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