Physical Therapy billing
Physical therapy is billed in units of time, and the unit math is where the money is. Get the 8-minute rule wrong in either direction and you are either leaving revenue on the table every single visit or building an overpayment.
What actually gets denied
Timed codes are billed in 15-minute units against total timed minutes, with Medicare's substitution rules differing from some commercial payers' per-code approach. Applying one payer's method to all of them creates systematic under- or over-billing.
Evaluation codes and modalities like unattended electrical stimulation are one-per-day services regardless of duration.
Once a beneficiary passes the annual therapy threshold, continued medically necessary care needs the KX modifier and documentation supporting it. Omit it and the claim denies; append it without support and it becomes an audit exposure.
97140 with 97530 is a standing NCCI edit pair requiring genuinely separate time blocks.
Payer behavior
Medicare requires physician certification of the plan of care and recertification at defined intervals; a lapsed certification denies every visit behind it.
Commercial plans frequently authorize visits in blocks and require clinical updates to extend them.
CQ and CO modifiers apply to services furnished in whole or part by assistants and carry a payment differential.
Documentation traps
Without total timed minutes, units cannot be defended on any payer's method.
Progress notes need objective, measurable change to support continued necessity.
Cloned documentation is the single most common finding in therapy audits.
Every physical therapy account is staffed by coders who bill this specialty daily. The work spans our full medical billing and revenue cycle management services — coding, claim scrubbing, denial management and A/R recovery — and you can see how engagements are structured on our pricing page. For the full specialty bench, go back to all specialties we bill, or contact us at (555) 555-0142.
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