Visit limit exceeded
Commercial plans cap therapy visits per year and combine PT with OT or chiropractic. Core MB verifies remaining visits at intake and tracks the count so authorizations are extended before the cap hits.
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Physical therapy medical billing services
Physical therapy billing lives on timed codes, modifiers and a plan of care that payers can audit at any point. Whether a claim pays depends on counting minutes correctly under the eight-minute rule, attaching GP and KX when they apply, keeping certifications current, and tracking each payer's visit limits and authorization windows before the patient walks in.
What makes physical therapy billing different
Outpatient therapy has its own rulebook that most multi-specialty billing teams never learn properly. Here is what we work with every day.
- Evaluations are tiered by complexity as 97161, 97162 and 97163, with 97164 for re-evaluation, and the documented history, examination findings and clinical decision making must support the level selected or the payer will down-code or deny it.
- Timed codes such as 97110, 97112, 97140 and 97530 are billed in 15-minute units under Medicare's eight-minute rule, with total timed minutes deciding the unit count across the visit rather than minutes per code.
- Every line carries the GP modifier, and once a Medicare patient crosses the annual therapy threshold the KX modifier attests that continued care is medically necessary; services by a PTA under supervision also carry the CQ modifier.
- NCCI pairs such as 97140 with 97530 require separate timed services and the 59 or X modifier with notes showing distinct interventions, and the plan of care must be certified and recertified on schedule.
Denials we see most in physical therapy
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Missing plan of care certification
Medicare and many payers deny when the signed physician certification or recertification is late or absent. We track certification dates per patient and flag expiring plans weeks ahead.
Bundled therapy codes
Payers reject 97140 or 97530 as inclusive to another code billed the same day. Core MB reviews minutes and documentation, applies the correct distinct-service modifier and appeals with the note attached.
How Core MB bills for physical therapy
Core MB treats therapy billing as a daily discipline rather than a monthly batch. Claims are coded from the flowsheet, scrubbed against NCCI and payer rules, and followed until paid, while credentialing for new therapists runs in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Unit counts are checked against documented timed minutes before any claim leaves, so eight-minute rule errors never reach the payer.
- Authorization and visit counts are tracked per patient per payer with alerts before the last approved visit.
- Medicare threshold tracking adds KX at the right point and prepares records for targeted medical review.
Everything in the service
From benefit verification through credentialing, Core MB covers the entire revenue cycle for physical therapy practices so your front desk and therapists can stay focused on patients.
- 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 therapy billing questions
How does the eight-minute rule affect how many units we can bill?
Under Medicare's rule, total timed minutes across all timed codes in a visit set the unit count: eight to twenty-two minutes supports one unit, twenty-three to thirty-seven supports two, and so on. Core MB checks the flowsheet totals against the units billed so claims match the record and survive review.
Why do payers keep denying our plan of care?
Most plan of care denials come from certification timing. Medicare requires the physician signature within a reasonable window and recertification at least every ninety days or when the plan changes. We log certification and recertification dates for every patient and send reminders to the referring office before a lapse.
Can we bill a re-evaluation when the patient's condition changes?
Yes, 97164 is appropriate when there is a documented new clinical finding, a significant change in status or a failure to respond that requires revising the plan of care. Routine progress notes do not qualify. Core MB reviews the note to confirm the trigger is documented before billing it.
How do we get started with Core MB for physical therapy billing?
Submit the quote form with your payer mix, therapist count and current software. We review your setup, propose a transition plan and run new claims alongside your current billing so nothing drops. Credentialing for new therapists or payer enrollments can start at the same time through the same portal.
Get therapy claims paid on the first submission
Core MB handles units, modifiers, certifications and visit limits for physical therapy practices across the country, with Brooklyn-based staff who know the rules.