MedCare Billing Solutions specializes in physical therapy billing for outpatient PT clinics, hospital-based therapy departments, and multi-discipline rehab practices. Our certified coders know every timed code rule, KX modifier requirement, and Medicare cap exception — so you collect every treatment unit you deliver.
Physical therapy billing is governed by the 8-minute rule, timed vs. untimed code distinctions, and Medicare's therapy cap with KX modifier exceptions. PT practices using non-specialized billing staff routinely leave 20–30% of revenue uncollected due to:
The average PT clinic with 4 therapists leaves $80,000–$180,000/year on the table from unit under-counting, missing KX modifiers, and wrong evaluation levels. MedCare's therapy billing specialists recover that revenue.
Our PT billing specialists apply the 8-minute rule and timed code methodology to maximize every treatment session.
| CPT Code | Service | Common Billing Issue |
|---|---|---|
| 97161–97163 | PT Evaluation (low / moderate / high complexity) | Always billing 97161 regardless of clinical complexity; revenue loss = $40–$70/eval |
| 97110 | Therapeutic exercises (timed, per 15 min) | Billing 1 unit flat regardless of time; under-billing by 2–3 units per session |
| 97530 | Therapeutic activities (timed, per 15 min) | Not billed separately from 97110 when distinct activities performed |
| 97012 | Mechanical traction (untimed) | Billing as timed — creates overpayment liability |
| 97035 | Ultrasound therapy (timed, per 15 min) | Missing time documentation; billed as 1 unit when 2 applicable |
| 97140 | Manual therapy techniques (timed) | Bundled with 97110 when billed on same day — needs -59 modifier |
| 97010 | Hot/cold pack application (untimed) | Billed with time units instead of flat untimed code |
| 97150 | Therapeutic exercises, group (untimed) | Billed as individual 97110 for group sessions — compliance risk |
Real-time eligibility verification and prior authorization management for physical, occupational, and speech therapy visits before every episode of care begins.
Certified therapy coders who apply the 8-minute rule correctly, select the right evaluation level, and identify every timed vs. untimed code distinction for maximum reimbursement.
Electronic claim submission within 24 hours. GP/GO/GN modifiers applied automatically. KX modifier tracked and applied when Medicare therapy cap is reached.
We appeal every medical necessity denial, missing modifier rejection, and plan-of-care documentation dispute with clinical documentation support from your therapists.
We track every Medicare patient's therapy cap utilization and apply KX modifiers proactively when the exception applies — preventing unnecessary claim denials.
Full PT/OT/SLP credentialing with Medicare, Medicaid, and all major commercial payers. We handle new therapist enrollment to prevent revenue gaps when you hire.
Get a free, confidential PT billing audit. We'll review your unit counts, modifier usage, and evaluation levels — and show you exactly how much your clinic is leaving on the table.