Unit miscalculation
Timed codes denied or reduced. Units calculated from documented minutes under each payer's rule.
Home / Specialties / Physical Medicine
Physical Medicine medical billing services
Physical medicine and rehabilitation bills E/M, electrodiagnostics, injections and therapy services under rules on time-based codes, the 8-minute rule, plan-of-care certification and payer therapy caps. Precision in units and documentation is what keeps rehab revenue stable.
What makes physical medicine billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether physical medicine claims pay the first time.
- Timed therapy codes (97110, 97112, 97140) follow the 8-minute rule for Medicare and per-payer unit rules elsewhere.
- Plans of care must be certified and recertified on schedule for therapy to remain covered.
- Electrodiagnostic studies and injections follow the same unit, guidance and medical-necessity rules as neurology and pain management.
- Therapy thresholds and the KX modifier apply to Medicare therapy services above annual amounts.
Denials we see most in physical medicine
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Plan-of-care lapses
Therapy denied for expired certification. Recertification dates tracked.
Threshold modifier omissions
Claims denied above the therapy threshold without KX. Applied where medical necessity is documented.
How Core MB bills for physical medicine
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new physical medicine providers runs in the same system, tracked live in your client portal.
- Unit calculation under the 8-minute rule and payer variants.
- Plan-of-care and recertification tracking.
- Threshold and modifier management for Medicare therapy.
Everything in the service
The full revenue cycle as standard for physical medicine practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Physical Medicine billing questions
What is the 8-minute rule?
Medicare's method for converting documented therapy minutes into billable units for timed codes. Commercial payers may use different rules, and we apply each correctly.
Why was therapy denied after a few months?
Often because the plan of care certification expired. We track recertification dates so coverage continues.
Do you handle the therapy threshold and KX modifier?
Yes. Above the annual threshold, medically necessary therapy continues with the KX modifier and supporting documentation.
How do we get started with Core MB for physical medicine billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new physical medicine providers can start at the same time.
More in therapy, rehabilitation and musculoskeletal
Find out what your physical medicine billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.