Specialty
Physical Therapy Billing
Physical therapy combines timed treatment units with mandatory plan-of-care documentation and payer visit caps, which is why loose tracking shows up as denials rather than as warnings.
What makes it different
The things that decide whether these claims get paid.
- Timed units are calculated, not estimated
- Treatment is billed in time increments with specific rules about how partial units are counted. Consistent rounding in the practice's favour is a well-known audit trigger; rounding against it is a quiet loss.
- Plans of care expire
- Treatment requires a certified plan of care, recertified at intervals. Visits delivered after expiry are generally not payable, regardless of medical necessity.
- Visit caps vary by payer
- Many plans limit therapy visits per condition or per year. Exceeding the cap without a documented exception produces denials for care already given.
- Modifiers decide whether concurrent services pay
- Services delivered in the same session frequently need modifiers to be reimbursed separately. Missing them is among the most repeatable losses in the specialty.
Where the money goes
Four leaks specific to Physical Therapy.
A healthy practice in this specialty collects around 95% of billed charges. Most of the gap below that is made up of these.
- Visits delivered after a plan of care lapsed
- Timed units rounded inconsistently
- Treatment continued past a payer's visit cap without documented exception
- Modifiers omitted on concurrent services
| Measure | Result | Reference |
|---|---|---|
| Collection rate | 95.0%OK | > 94% |
| Days in A/R | 28OK | < 30 |
| Denial rate | 4.0%OK | < 5% |
| A/R over 90 days | 8.0%OK | < 10% |
Illustrative figures — not a client result.
Questions
Asked most often.
What is the most common physical therapy denial?
An expired plan of care. It is administrative rather than clinical, which makes it both frustrating and almost entirely preventable with a recertification calendar.
How should timed units be handled?
Consistently, and documented. The specific rule matters less than applying one rule every time and being able to show the treatment time that supports it.