Specialty billing / Physical Therapy
Physical therapy billing is arithmetic performed on treatment minutes. Timed codes convert to units under a specific counting rule, untimed codes pay once per session regardless of duration, and certain code pairs need a distinct service modifier to survive edits. Above that sits a plan of care that must be certified and recertified on schedule.
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Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
Total timed minutes determine total billable units, then units are allocated across the services performed. Counting each code separately instead of totaling first produces both overbilling and underbilling, sometimes within the same visit.
Therapy requires a physician-certified plan of care with recertification at defined intervals. Treatment continuing past an expired certification is not payable, and the lapse typically surfaces after weeks of visits have already been provided.
Therapeutic exercise, therapeutic activities, neuromuscular reeducation and manual therapy describe different interventions. Notes that say strengthening exercises for every visit cannot support the mix of codes billed when a record request arrives.
Most plans cap therapy visits per year and require authorization after an initial allowance. Sessions delivered while a reauthorization is pending are commonly denied, and patients rarely accept a bill for a visit they were told was covered.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Add all timed treatment minutes for the visit, then divide by 15 to find total billable units, with a remainder of 8 or more minutes supporting one additional unit. Allocate those units to the services performed, giving priority to the interventions with the most time. Untimed codes are billed once regardless of duration.
Medicare requires certification of the plan by a physician or qualified practitioner and recertification at defined intervals, commonly every 90 days or when the plan changes significantly. Commercial plans set their own schedules. Tracking each patient's certification date is the only reliable way to avoid delivering uncompensated visits.
When two codes that are normally bundled were genuinely performed as distinct services, typically in separate time blocks or on separate anatomic sites. Manual therapy with therapeutic exercise is the common pairing. The daily note must show the separation. Applying the modifier as a routine habit is a well-known audit trigger.
Therapeutic exercise addresses strength, endurance, range of motion and flexibility through specific exercises. Therapeutic activities involve dynamic, functional tasks such as lifting, carrying, transfers or reaching to restore an activity the patient needs. The note should describe the activity and its functional purpose, not just the body part treated.
We track authorized visits and expiration dates per patient and flag reauthorization before the last approved visit, not after. Because reauthorization usually requires updated progress documentation, giving your therapists notice while the patient is still on schedule is what keeps treatment continuous and billable.
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