Physical Therapy & Rehabilitation Billing Services

Physical therapy billing turns a visit into units, and whether that visit pays as two units or three can depend on nothing more than which counting rule the billing system applied. Most treatment codes are timed in 15-minute increments, evaluations bill once by complexity, and modifiers, thresholds, and payment reductions layer on top. A practice that counts minutes wrong loses a unit on visit after visit, and a practice that counts them aggressively invites audits.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for physical therapy and rehabilitation practices, built around the time and modifier rules that actually decide whether therapy claims pay.

Physical therapy & rehabilitation billing challenges

The 8-minute rule is the core discipline. Medicare converts total timed minutes to units: 8 to 22 minutes is one unit, 23 to 37 minutes is two units, and so on, pooling the minutes across all timed codes in the visit rather than counting each code separately. Many commercial payers instead count minutes per code, which gives a different answer for the same visit, so the billing system must apply the right rule per payer. Common timed codes include therapeutic exercise (97110), neuromuscular reeducation (97112), gait training (97116), manual therapy (97140), and therapeutic activities (97530), while evaluations (97161 through 97163) and reevaluations (97164) are untimed and billed once per session.
Modifiers decide whether those units pay. Medicare requires the GP modifier on physical therapy services to show they are furnished under a physical therapy plan of care, and a missing GP modifier is a common outright denial. Services furnished in part by a physical therapy assistant carry the CQ modifier on Medicare claims. Claims above Medicare’s annual therapy threshold need the KX modifier with documented medical necessity, and applying KX from the start of the year is a recognized audit trigger. The multiple procedure payment reduction also applies: the practice expense component of the second and subsequent therapy services on the same day is reduced, so expected payment must be modeled correctly rather than assumed at full rate.
Rehabilitation billing adds plan-of-care and authorization discipline. Therapy plans need documented goals and progress, visits need authorization tracking where payers require it, and lapses in either produce denials that look like coding problems but are really documentation problems.

What MedPlus RCM handles for physical therapy & rehabilitation practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
    We serve physical therapy and rehabilitation practices of every size, including outpatient orthopedic, neurologic, pediatric, sports, pelvic health, and hospital-based rehabilitation practices.

Results physical therapy & rehabilitation practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

How does the 8-minute rule work?
Medicare pools all timed minutes in the visit and converts them to 15-minute units: 8 to 22 minutes is one unit, 23 to 37 is two, and so on. Some commercial payers count per code instead, which can change the unit count for the same visit.
Why do our claims deny for a missing modifier?
Usually GP, which Medicare requires on physical therapy services. Assistant-furnished services need the CQ modifier, and claims above the annual therapy threshold need KX with documented medical necessity.
Do you bill for physical therapy assistants?
Yes. Assistant services are billed under the supervising therapist, with the CQ modifier on Medicare claims, and supervision requirements are set per payer and state rules.
What is the multiple procedure payment reduction?
On the same day, the practice expense component of the second and subsequent therapy services is reduced. We model expected payment accordingly so your reports reflect what payers will actually pay.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your physical therapy practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
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