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For outpatient PT clinics and private practices
Physical therapy billing that gets every visit paid.
Billing, authorization tracking, denial follow-up and credentialing for outpatient PT clinics and private practices. Timed codes, modifiers and Medicare therapy rules handled right the first time, so visits get paid instead of bundled or denied.
- HIPAA BAA signed first
- Works inside WebPT, Prompt and your EMR
- No setup fee
In five months, our net collections went from $3,000 to $15,000 a month. A team that genuinely cares about getting every claim paid.Angel, Office Manager, physical therapy practice
Every minute you treat, billed and paid.
PT claims are dense: several timed codes, modifiers and a plan of care behind every visit. Small errors add up fast across a full schedule.
Get a free claims reviewUnits that match your minutes
Timed minutes turned into the right units for Medicare and for each commercial payer’s own rules.
No more bundling surprises
Code pairs that trigger payer edits are caught and supported before the claim goes out.
Plans of care that stay current
Authorizations, visit caps, certifications and progress reports tracked for every patient.
Denials worked, not written off
Bundling, medical necessity and benefit-max denials appealed with the notes the payer needs.
Everything between the visit and the deposit
One team runs the whole cycle for your clinic, from the first eval to the last payment.
Benefits and visit limits
Therapy visit caps, copays, deductibles and authorization rules checked before the evaluation, and tracked across the plan of care.
Authorization tracking
Approved visits and date ranges tracked per patient, with extension requests sent before the auth runs out.
Timed code billing
Units calculated correctly under the 8-minute rule for Medicare and each payer’s own rules for commercial plans.
Modifiers done right
The right therapy modifiers on every line, including assistant services, edit pairs and the Medicare threshold.
Denials and appeals
Bundling, medical necessity and benefit-max denials worked and appealed with the plan of care and progress notes.
Credentialing
Payer enrollment for new therapists and new locations, plus CAQH and Medicare revalidation.
Four causes behind most therapy denials
Fix the cause, and the same denial stops coming back.
Procedures paid as one
Some code pairs, such as manual therapy with therapeutic activities, trigger payer edits. Without a supported modifier, the payer pays one and denies the other.
Benefit maximum or threshold reached
Commercial plans cap visits per year. Medicare requires the KX modifier once a patient passes the annual therapy threshold. Miss either and the visit goes unpaid.
Authorization used up
Visits past the authorized count or date range are denied, often weeks later when the patient is mid-plan.
Plan of care gaps
Medicare needs a certified plan of care and regular progress reports. Missing signatures or progress notes turn into medical necessity denials.
Two more ways we take work off your plate
Growing PT clinics hit the same two walls: new therapists waiting on insurance panels, and a front desk buried in scheduling, insurance checks and authorizations.
New therapist or location? We get you in-network.
Every week a new therapist waits on credentialing is a week of visits you can’t bill in-network. We handle it from start to finish.
- CAQH and Medicare enrollment through PECOS
- Applications to the commercial plans your patients use
- Follow-up with every payer every two weeks
Front desk buried in scheduling?
A HIPAA-trained assistant books and reschedules visits, checks benefits and requests authorizations, inside your systems.
- Scheduling, reschedules and plan-of-care bookings
- Benefits, visit limits and authorization requests
- Reminder calls and waitlist fills for cancellations
PT billing lives and dies on timed codes.
A 45-minute visit split across three services has to be broken into the right units, with the right modifiers, against the right plan of care. Get one piece wrong and the payer underpays or denies the whole line.
We work inside your practice management or EMR system and check every claim against Medicare and payer-specific therapy rules before it goes out.
- Units that match your minutesTimed codes billed under Medicare’s rules and each commercial payer’s own.
- Visit limits and authorizations trackedCaps, authorized visits and date ranges watched for every patient.
- Plans of care kept currentCertifications and progress reports flagged before they cost you a visit.
Who we work with
Single-therapist practices to multi-location groups.
Payer rules we handle
The rules behind most PT underpayments and denials.
Switching takes about two weeks
No new software and no gap in claims. You keep seeing patients while we set up.
Free claims review
We look at your denied and unpaid claims and show you what is recoverable, in 3 business days.
BAA and access
We sign a Business Associate Agreement, then get user access to your EHR and clearinghouse.
Clean-up and setup
We work the open AR, fix payer setup issues and confirm your fee schedules.
Claims go out daily
Claims, payments and follow-up run every day, with a report you can read each month.
Physical therapy billing questions
Still unsure? Email info@carerevenuemanagement.com or call (850) 515-4548.
How does the 8-minute rule affect billing?
For Medicare and payers that follow its rules, you add up all timed minutes in a visit and convert them to units: 8 to 22 minutes is one unit, 23 to 37 is two, and so on. Units are then assigned across the services performed. Billing each code on its own minutes can overbill or underbill.
When do we need the KX modifier?
For Medicare patients, once their therapy costs for the year pass the annual threshold, each claim needs the KX modifier to show the care is still medically necessary, along with documentation that supports it.
Do you bill for PTAs?
Yes. Services delivered in whole or in part by a physical therapist assistant need the CQ modifier for Medicare, which also changes the payment amount. We apply it correctly so claims don’t get flagged.
Do I need to switch from WebPT or Prompt?
No. We work inside the system you already use. You keep your scheduling and documentation the way they are.
Can you credential a new location or new therapist?
Yes. We handle payer enrollment, CAQH, and Medicare enrollment through PECOS, and follow up until each payer has you in-network.
See what your clinic is owed
Send us a few details. We’ll review your denied and unpaid PT claims and show you what’s recoverable, free, in 3 business days.