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Physical therapy billing services · PT RCM · 8-minute rule · GP, KX, CQ
PhysiAssist runs billing for physical therapy and rehab practices: benefits, visit limits and authorizations checked before the first visit, CPT units counted to the 8-minute rule, GP, KX and CQ modifiers applied, plans of care tracked, and denials and AR worked to the end.
8-minute rule unit calculator
Try itUnits to bill
Total timed minutes
Timed CPT codes, one-on-one time only; payer policies vary
The basics
Physical therapy billing services manage the revenue cycle of a PT or rehab practice: verifying benefits, visit limits and authorizations, coding evaluations and timed treatment codes with the right units and modifiers, tracking plans of care, submitting claims, and working denials and AR. In therapy billing, most lost revenue comes from units, modifiers and expired authorizations, not from the claim form.
Visit limits, copays and authorizations confirmed before the first appointment.
8-minute rule, GP, KX, CQ and NCCI edits checked on every claim.
Certification, recertification and progress report dates tracked.
Medical necessity, unit and authorization denials appealed and fixed.
What we check
| Codes | What they cover | What we check |
|---|---|---|
| 97161 · 97162 · 97163 · 97164 | PT evaluation, low, moderate and high complexity; re-evaluation | Complexity supported by the note; untimed, 1 unit |
| 97110 · 97112 · 97116 | Therapeutic exercise, neuromuscular re-education, gait training | Units match documented one-on-one minutes |
| 97140 · 97530 | Manual therapy, therapeutic activities | NCCI pair: separate time blocks, 59 or XU |
| 97535 · 97750 · 97760 | Self-care training, physical performance test, orthotic training | Timed units and medical necessity |
| G0283 · 97014 | Unattended electrical stimulation, Medicare and commercial | Right code for the payer, untimed |
| GP · KX · CQ | PT plan of care, threshold exceeded, assistant-furnished | Applied by payer and by who treated |
| 59 · XU · ICD-10 | Distinct service, diagnosis | Edits cleared; diagnosis supports the plan of care |
Free physical therapy billing audit
Send us a recent month of therapy claims. A certified coder checks units against minutes, modifiers and plans of care, and sends a written report you keep, whether or not you work with us.
Claims reviewed
1,280With an issue
104Dollar impact
$14,800What the report covers
Outpatient PT, OT, speech and rehab
Therapy is billed in 15-minute units, under a plan of care, against visit limits. We track all three, so a missed recert or an uncounted unit does not quietly cost you a visit's pay.
The systems we work in every day
We log in to your system; nothing about it changes for your team.
Claims, rejections and remittances worked through your clearinghouse.
Submissions, status checks and renewals in each payer's own portal.
Pricing
One rate of 2.8% to 5% of net collections, quoted in writing before you sign. Where you land depends on monthly collections, specialty mix, the scope of services, and your AR backlog and payer mix.
The rate covers medical coding, claim submission, payment posting, denials and AR follow-up. Front desk services, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
See full pricing and estimate your rate →Insurance and benefits verification, visit limits and authorizations, plan of care tracking, CPT coding with the right units and modifiers, claim submission, payment posting, denials and appeals, AR follow-up and patient billing.
The 8-minute rule decides how many units of a timed CPT code you can bill. A unit needs at least 8 minutes. For Medicare, all timed minutes are added up first: 8 to 22 minutes is 1 unit, 23 to 37 is 2, 38 to 52 is 3, and so on.
GP tells the payer that a service was delivered under an outpatient physical therapy plan of care. Medicare requires it on every therapy line, with GO for occupational therapy and GN for speech-language pathology.
KX tells Medicare that therapy above the yearly threshold is medically necessary and documented. Without it, claims above the threshold are denied. Claims above a higher amount may also go to targeted medical review.
CQ and CO mark services furnished in whole or in part by a physical therapist assistant or occupational therapy assistant. Medicare pays those services at 85% of the fee schedule, so the modifiers must match who actually treated the patient.
97161 to 97163 for evaluations by complexity, 97164 for re-evaluation, 97110 therapeutic exercise, 97112 neuromuscular re-education, 97116 gait training, 97140 manual therapy, 97530 therapeutic activities and 97535 self-care training.
Yes, when they are separate services in separate time blocks. The pair has an NCCI edit, so 59 or XU is needed on the right line, and the note must show distinct minutes for each.
Yes. We enroll therapists and groups with Medicare, Medicaid and commercial plans, keep CAQH current, and add new therapists before their first visit.
PhysiAssist charges 2.8% to 5% of net collections for coding, claims, payment posting, denials and AR, quoted in writing before you sign.
We review recent therapy claims and send a written report: units against documented minutes, GP, KX, CQ and 59 modifiers, plan of care and recertification dates, authorization and visit limits, denials by root cause and the dollar value of each.
A free physical therapy billing audit by a certified coder, with a written report you keep.