SpecialtiesTherapy & rehabilitation
How we see physical therapy billing.
Reviewed by the VisMed therapy & rehabilitation billing team
A physical therapy claim is built from timed codes counted in units by total treatment minutes, plus untimed codes billed once per visit. The unit rules are specific and payers audit them. Every visit also has to fall under a plan of care that is certified by a physician within a window, recertified on schedule, and supported by progress notes at set intervals. A lapse in certification makes every visit after it unbillable, and it is discovered months later.
Medicare adds a threshold above which a modifier attests to medical necessity, and a higher threshold that triggers targeted review. Commercial payers add visit caps and authorizations with counts that run out mid-episode. Assistants have their own modifiers and payment reductions.
On a physical therapy account, VisMed calculates units from the treatment record rather than the charge sheet, keeps a certification and progress-note calendar per patient, tracks authorization counts per episode, and applies the modifier rules per payer.
Where physical therapy practices lose money
The patterns we find in the aging and denial history before anything else changes.
Units miscounted
Timed units follow total timed minutes across codes, not minutes per code. Practices counting per code bill too many or too few units on nearly every visit.Certification lapses
A plan of care not signed inside the window, or not recertified on time, makes the visits in the gap unbillable and recoupable.Progress notes missed
Medicare requires a progress note at set visit intervals. Missing one is a documentation failure that puts the episode at risk.Authorization counts exhausted
Commercial authorizations approve a number of visits over a period. Visits beyond them are unpaid unless a new request went out ahead.Threshold and assistant modifiers
The medical-necessity modifier above the annual threshold and the assistant modifiers for services furnished by assistants are omitted or misapplied, denying or reducing claims.
What we do differently for physical therapy
Specialty-matched coders and a denials specialist, working inside your own system.
We calculate units from the record
We total timed minutes per visit, assign units by the rule, bill untimed codes once, and check the result before the claim leaves.We keep a compliance calendar per patient
Certification due dates, recertification, progress-note intervals and authorization counts are tracked per episode, and we alert the clinic ahead of each deadline.We chase physician signatures
We send plans of care for signature and follow up until they are returned, so the certification window is met.We apply modifier rules per payer
Threshold, assistant and telehealth modifiers are applied per plan at charge entry.
What we bill
The procedure and code families your account team already works in.
Physical therapy billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed count timed units?
VisMed totals timed minutes across all timed codes in the visit, applies the unit rule to the total, then distributes units to codes by the minutes spent on each. Untimed codes are billed once regardless of time. We calculate this from the treatment record on every visit.
What happens when a plan of care is not signed in time?
Visits in the gap are technically unbillable for Medicare and recoupable if paid. VisMed chases physician signatures from the day the plan is sent, and our compliance calendar warns the clinic before any window closes.
How does VisMed track commercial authorizations?
Per episode, with the approved visit count and dates. VisMed sends a new request before the count is exhausted so treatment continues without unpaid visits.
Do assistant-furnished services pay less?
For Medicare, yes, when the assistant furnishes the service in whole or in part, and the modifier must say so. VisMed applies the assistant modifiers from the treatment record per payer rules.
Does VisMed handle the Medicare KX threshold?
VisMed tracks each Medicare patient’s running total against the annual threshold, applies the KX modifier with the supporting documentation once it is crossed, and flags patients approaching the targeted-review threshold so the clinic can plan.
Also in therapy & rehabilitation
Occupational therapy
Plan-of-care certification and caps.
Speech therapy
Evaluation vs treatment, pediatric Medicaid.
ABA therapy
Adaptive-behavior codes, authorization units and BCBA supervision.
Chiropractic
AT modifiers, maintenance rules and Medicare limits.
Podiatry
Routine foot-care exceptions and DME.
All specialties
The full list, in six groups
See where your physical therapy practice is losing money. Free.
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