Expert Physical Therapy Billing for a Profitable Practice
At Hometown Billing, we specialize in physical therapy medical billing services. We help ensure compliance, accurate coding, and maximum reimbursement for PT practices, outpatient rehab facilities, sports therapy clinics, and more.
Physical therapy (PT) billing is complicated and presents many challenges. Billing processes involve unique CPT codes, Medicare’s 8-minute rule, and prior authorization needs. There are also frequent denials for medical necessity.
At Hometown Billing, our experienced team manages the entire PT revenue cycle. We help reduce denials, speed up reimbursements, and optimize cash flow. Contact us now to learn more and experience the difference we can make for your practice.
Why PT Billing Requires Specialized Knowledge
Billing for physical therapy services is complex and highly regulated, requiring precise documentation, coding, and compliance with payer-specific policies. Common PT billing challenges include:
- Complex timed codes – Using CPT codes for timed vs. untimed procedures (e.g., manual therapy, therapeutic exercises)
- The 8-Minute Rule – Ensuring correct billing under Medicare guidelines
- Medical Necessity Denials – Justifying continued PT treatment with detailed documentation and progress tracking
- Insurance Variability – Managing prior authorizations, treatment caps, and patient responsibility calculations
Hometown Billing understands the intricacies of physical therapy billing. We provide expert claims management for timely reimbursements and regulatory compliance.
Our Physical Therapy Billing Services
We offer end-to-end billing solutions to meet the needs of physical therapists and their practices.
- Insurance Verification & Pre-Authorization
- Verify a patient’s insurance coverage and benefits
- Identify visit caps and pre-authorization requirements for care
- Ensure compliance with payer-specific medical necessity criteria
- CPT Coding Compliance for Billing
- Expert billing for one-on-one therapy and group therapy sessions
- Compliance with the 8-minute rule for time-based codes
- Ensure proper use of CPT modifiers (GP, KX, 59, etc.)
- Claims Submission & Denial Management
- Accurate, first-time claim submission to reduce rejections
- Appeals and resubmission for denied claims (e.g., medical necessity, authorization issues)
- Tracking underpaid claims and negotiating insurance reimbursements
- Revenue Cycle Management & Collections
- Collect payments, both from insurance companies and patients
- Accounts receivable (A/R) follow-up to prevent revenue loss
- Transparent billing for PT with payment plan options for patients
- Maximizing reimbursements while minimizing bad debt write-offs
- Compliance & Audit Support
- Adherence to Medicare, Medicaid, and commercial payer guidelines
- Billing compliance audits to spot risk areas before insurer audits
- Ensure accurate therapy progress notes and treatment reasoning
When you work with our experts, you benefit from professional end-to-end RCM for your practice. Hometown Billing handles the entire process, from a patient’s first point of contact through to the final payment.
Physical Therapy Procedures & Services We Bill For
We specialize in billing for a wide range of physical therapy treatments, including:
- Therapeutic Exercises (97110)
- Manual Therapy (97140)
- Neuromuscular Reeducation (97112)
- Gait Training (97116)
- Therapeutic Activities (97530)
- Electrical Stimulation (97014, 97032)
- Ultrasound Therapy (97035)
- Massage Therapy (97124)
- Aquatic Therapy (97113)
- Evaluation & Re-Evaluation (97161-97163)
- Group Physical Therapy (97150)
- Kinesiology Taping & Myofascial Release
We ensure correct coding, modifier usage, and compliance with insurer-specific regulations to maximize reimbursements.
Why Choose Hometown Billing?
Hometown Billing is a trusted partner for physical therapy providers, offering:
- A skilled team of experts with over 36 years of combined experience in medical billing and revenue management
- Proficiency in various practice management and billing software technologies
- PT-specific coding specialists who fully understand medical billing codes for physical therapy services
- Dedicated account managers for real-time revenue insights and claims performance tracking
- HIPAA-compliant processes that ensure secure and confidential patient data
- Proven success in increasing collections and reducing insurance claim issues
- Secure and efficient management and billing software for electronic claims processing, record tracking, and more
We help clinics optimize and manage every aspect of medical billing for physical therapy services. With our assistance, you can concentrate on patient care rather than administrative tasks while still protecting your practice. Find out what sets us apart.
Expert Billing for Your Physical Therapy Practice
Hometown Billing is your partner in physical therapy billing success. We carry over 36 years of combined experience in medical billing, and our knowledge spans multiple service areas.
Contact us to discover how we can help your PT practice increase revenue, reduce claim denials, and streamline revenue cycle management.
FAQs About Physical Therapy Billing
What is the 8-Minute Rule in PT billing?
The 8-minute rule applies to Medicare, occasionally Medicaid, and some private insurers. It’s a guideline that determines how many units of time-based services can be billed during a single patient visit. At least 8 minutes of service is required per billable unit for time-based CPT codes.
How does Hometown Billing reduce denials for PT claims?
We focus on accurate coding, pre-authorization verification, and thorough documentation to prevent common claim rejections.
Do you handle out-of-network PT billing?
Yes, we assist with negotiations for out-of-network reimbursements to help increase payments.
Can Hometown Billing help with self-pay and patient billing?
Absolutely! We offer patient-friendly billing solutions and custom payment plans for self-pay patients.
What types of physical therapy clinics do you serve?
We support private practices, outpatient clinics, rehabilitation centers, hospital-based therapy, sports medicine facilities, and more.
Why is modifier use important in PT billing?
Modifiers clarify the nature of services provided and are required for proper claim processing and compliance. Incorrect use can lead to denials.
What are the most common reasons physical therapy claims are denied?
Denials often stem from missing documentation, incorrect use of modifiers, billing errors, absence of medical necessity details, and failure to get pre-authorization.
How does prior authorization affect physical therapy billing?
Many insurance plans require prior authorization for PT treatments. Failure to obtain it can result in denied claims and lost revenue. Hometown Billing manages pre-authorization to ensure timely approval and payment.
