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Physical Therapy Billing

Timed units, the 8-minute rule, plan-of-care certification and therapy thresholds — PT billing that survives payer scrutiny.

Physical therapy is paid in timed units and audited in retrospect, which makes documentation discipline the whole game. Elite Bill Care's physical therapy billing handles unit counting, modifiers, certification tracking and cap management for outpatient PT practices.

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The rules this specialty lives by

  • Timed codes and the 8-minute rule — units for codes like 97110, 97112 and 97140 are earned in treatment time; total timed minutes decide units, and notes must support them.
  • Evaluation complexity — 97161–97163 are selected by documented complexity and clinical decision-making, not by habit.
  • GP modifier — required on Medicare outpatient PT services, with the KX modifier used when services exceed the annual threshold and remain medically necessary and documented as such.
  • Plan of care — certification by the referring provider, progress reports (at least once every 10 treatment days for Medicare), and recertification on the required cycle; billing under an uncertified plan invites denials.
  • Commercial visit caps — many plans cap PT visits per year or per condition, sometimes shared with OT/speech; caps are counted in eligibility checks, not discovered at the cap.

How we run it

Charges are reconciled against schedules (see charge entry), timed units verified against note totals, certifications tracked so no claim ships under a lapsed plan, and cap counts monitored per patient. Denials feed back into documentation coaching through denial management — see the wider service set on our billing services page.

Frequently asked questions

Do you track visit caps for us?

Yes — caps confirmed at eligibility and counted as visits bill, with the practice warned before a patient reaches the limit.

Can you bill for PTAs?

Yes, with the correct modifiers and each payer's supervision and payment rules for assistants (Medicare applies the CQ modifier and a payment differential for services furnished in whole or part by a PTA).

What documentation do auditors ask for in PT?

The evaluation, plan of care with certifications, daily notes with timed minutes, and progress reports. Our billing workflow checks these exist and agree with the units billed before claims go out.