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Specialized Physical Therapy Billing Solutions

Physical therapy billing is highly nuanced, requiring precise CPT coding, proper documentation, and strict compliance with Medicare and private payer rules. Missing modifiers, incorrect timed-code billing, or insufficient documentation can lead to claim denials, audits, and lost revenue.

Our team specializes in PT-specific billing, ensuring your practice gets paid accurately and on time while avoiding compliance risks.

Key Physical Therapy Billing Services We Handle

✅ Therapeutic Exercise (97110) – Timed billing (8-minute rule)
✅ Neuromuscular Re-education (97112) – Proper documentation for medical necessity
✅ Manual Therapy (97140) – Avoiding bundling issues with modifier 59
✅ Therapeutic Activities (97530) – Untimed billing rules
✅ Dry Needling (20560, 20561) – Differentiating from acupuncture
✅ Evaluations & Re-evaluations (97161-97164) – Ensuring correct complexity level
✅ Group Therapy (97150) – Compliance with payer-specific rules

Top PT Billing Challenges & How We Solve Them

1. Timed vs. Untimed Codes – Avoiding Costly Errors

  • Timed Codes (97110, 97112, 97140) – Billed in 15-minute increments (8-minute rule).

  • Untimed Codes (97530, 97535) – Billed per session, not by time.

  • Common Mistake: Confusing 97110 (timed) with 97530 (untimed).

2. Modifier 59 Misuse – Preventing Denials & Audits

  • Required for “distinct procedural services” (e.g., 97110 + 97140 on the same day).

  • Incorrect Use: Applying modifier 59 to bypass NCCI edits without justification.

  • Our Fix: We ensure modifier 59 is only used when services are separate and medically necessary.

3. Dry Needling Billing – Avoiding Acupuncture Confusion

  • Correct Codes: 20560 (first 15 mins), 20561 (each additional 15 mins).

  • Not Acupuncture: Must document musculoskeletal need, not general wellness.

4. Documentation Pitfalls – Proving Medical Necessity

  • Requires:

    • Clear treatment goals (e.g., “Improve ROM by 20% in 4 weeks”).

    • Progress notes showing functional improvement.

    • Physician referrals for Medicare compliance.

Why Choose Our PT Billing Services?

🔹 PT-Specific Expertise – We only bill for rehab services, ensuring deep compliance knowledge.
🔹 Reduced Denials – Our claim scrubbing catches errors before submission, improving approval rates.
🔹 Transparent Reporting – Monthly analytics on reimbursement trends, denial reasons, and underpayments.
🔹 Audit Protection – Documentation reviews to prevent RAC audits and takebacks.