Specialty
Physical Therapy Billing and RCM
Timed units, the 8-minute rule, and a plan of care that has to stay certified.
Why it’s different
PT is billed in units of time, and the arithmetic is unforgiving. The 8-minute rule decides how many units a session supports, and the documentation has to show the minutes to defend them.
Meanwhile the plan of care has to be certified and recertified on schedule. A lapse makes otherwise-clean claims unpayable, retroactively.
Common challenges
Where the money goes missing.
- The 8-Minute Rule
- Miscalculated across sessions that mix timed and untimed codes.
- Plan of Care
- Certification or recertification lapsing while treatment continues.
- Therapy Threshold
- KX modifier and the annual threshold not tracked per patient.
- NCCI Edit Pairs
- Modifier 59 and X-modifiers required on common code combinations.
- Evaluation Complexity
- Low, moderate or high complexity billed without documentation to support it.
How we help
We recalculate units against documented minutes before submission, track certification and recertification dates per patient, and monitor the annual threshold so the KX modifier is applied when it is actually needed.
We do not provide coders. Your clinical team assigns the codes. We verify and validate them.
Key codes
- CPT 97110 / 97112 / 97140 / 97530
- CPT 97161–97163
- Modifier KX
- Modifier 59 / XU
Indicative, not exhaustive. Code sets and payer policies change.
Get a Physical Therapy Billing Analysis
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