Physical therapy billing
Physical therapy billing,
without the denials.
Physical therapy claims are full of rules that are easy to miss: timed units, therapy thresholds, plan-of-care certifications and visit caps. We get them right so your therapists don't lose visits they already delivered.
What makes it hard
Where physical therapy revenue gets lost.
Timed units and the 8-minute rule
Most PT codes are billed in 15-minute units. For Medicare, units come from total timed minutes under the 8-minute rule; other payers may count each code separately.
Therapy thresholds
Medicare requires the KX modifier once a patient's therapy spending passes the annual threshold, confirming the care is medically necessary.
Plan of care
Therapy must follow a plan of care certified by the physician or non-physician practitioner within the required time frame, and recertified when it is due.
Visit limits and authorizations
Commercial plans often cap visits per year or send therapy authorizations through a utilization management company.
Required modifiers
Therapy discipline modifiers (GP for physical therapy) and assistant modifiers (CQ for PTA services) are required by Medicare and affect payment.
How we handle it
Checks built into every claim.
Our team and the GetMax platform apply these checks before claims go out, not after the denial comes back.
- Units checked against documented minutes before submission
- Threshold tracking per patient, with KX applied when it is required
- Plan-of-care certification and recertification dates tracked
- Visit and authorization counts tracked against each plan
- Discipline and assistant modifiers applied by payer rule
Frequently asked
Questions we hear a lot.
What is the 8-minute rule?
It is how Medicare converts timed treatment minutes into billable 15-minute units: a unit can be billed once at least 8 minutes of timed service are provided, based on the total timed minutes of the visit.
When is the KX modifier needed?
For Medicare patients, once their therapy costs for the year pass the annual threshold, claims need the KX modifier to confirm the services are medically necessary and documented as such.
Keep reading
Other specialties.
Specialty
Behavioral & mental health
Billing for therapists, psychiatrists and counseling groups: time-based psychotherapy codes, telehealth, authorizations and carve-out payers, handled.
Learn more →Specialty
Chiropractic
Chiropractic billing for Medicare and commercial plans: spinal manipulation codes, AT and GA modifiers, ABNs, documentation and visit limits handled.
Learn more →Specialty
Primary care
High-volume primary care billing: preventive and problem visits, modifier 25, wellness visits, chronic care management and fast eligibility checks.
Learn more →Let's look at your physical therapy numbers.
Tell us your payer mix and your biggest headache. We will show you what we would change.