Maximize Revenue for
Physical Therapy Practices
Physical therapy billing is governed by strict time-based coding rules and Plan of Care compliance. We master the 8-Minute Rule and therapy thresholds so you get paid for every minute of care you provide.
The 8-Minute Rule
We flawlessly calculate total timed minutes across multiple CPTs (e.g., 97110, 97140) to maximize your billable units without triggering over-billing audits.
Why Physical Therapy Needs Specialized Billers
PT billing is entirely different from standard physician billing. Missing a physician’s signature on a Plan of Care within 30 days, miscalculating timed vs. untimed codes, or failing to append Modifier 59 when combining manual therapy with therapeutic activities will result in immediate, unrecoverable denials.
Medicare 8-Minute Rule
We audit your daily notes to ensure timed codes (like 97110 and 97530) are correctly tallied. We prevent the common mistake of overbilling units based on individual code times instead of total session time.
Plan of Care (POC) Tracking
Medicare requires a signed POC within 30 days of the initial evaluation. We track these dates strictly, ensuring referring physician signatures are secured before claims are submitted.
KX Modifier & Therapy Caps
When patients cross the annual Medicare therapy threshold, we automatically append the KX modifier to certify ongoing medical necessity, ensuring continuous, uninterrupted payment.
Securing Revenue from
Evaluation to Discharge
We proactively manage your active patient roster, ensuring authorizations are renewed on time, visit limits aren't exceeded, and daily notes support the billed units.
Auth & Visit Limit Tracking
Commercial insurances have strict visit caps (e.g., 20 visits per year) and require frequent authorizations. We track this data meticulously before the patient enters the gym.
Modifier 59 Application
Therapists often perform NCCI bundled services (like manual therapy and therapeutic activities) on the same day. We properly apply Modifiers 59 or XE to prove distinct services.
GP Modifier Scrubbing
We ensure all claims strictly adhere to Medicare guidelines by automatically appending the GP modifier, signifying the services were delivered under a physical therapy plan of care.
Aggressive Denial Appeals
If a payer denies a claim citing "maximum benefit reached" or "lack of medical necessity," our team immediately submits your daily flowsheets and progress notes to overturn it.
Stop Treating Patients for
Free Due to Auth Denials
Partner with specialized rehab billers who understand the exact mechanics of Medicare’s 8-Minute rule, POC compliance, and therapy thresholds. Contact Valeria Healthcare Solutions today.