Physical Therapy Billing Services in Texas

Physical therapy runs on volume: a therapist’s day is a stack of timed services, and a practice’s revenue is the sum of hundreds of small units billed in 15-minute increments. That makes PT billing unforgiving: a claim rarely fails all at once. It pays a unit short, loses a visit to an expired certification, or crosses a threshold without the modifier that explains it — small leaks that stay invisible until someone adds up a quarter of them.

Fastora Medical Billing Solutions handles billing for physical therapy practices across Texas, from single-therapist clinics to multi-site outpatient groups. This page covers where PT claims break down, the Medicare rules behind them, what is different about billing therapy in Texas, and how we work those problems.

Unit billing and the 8-minute rule: small minutes, real money

Most PT revenue is billed in timed units. Therapeutic exercise, manual therapy, neuromuscular re-education, gait training — the codes that fill a therapy schedule are timed codes, billed in 15-minute units. Under Medicare’s 8-minute rule, units are based on the day’s total timed minutes, not on each code in isolation: a timed service must reach at least 8 minutes to count at all. Eight to 22 minutes of timed treatment supports one unit, 23 to 37 supports two, 38 to 52 supports three. Twenty-two minutes billed as two units is an overpayment waiting to be recouped; thirty-eight billed as two is revenue earned and never collected.

The errors are usually process errors, not knowledge errors. Charges get entered from the appointment schedule instead of actual treatment time. A therapist documents total visit time but not how it split between timed and untimed services. A front desk rounds every session to a standard block. Each habit is understandable, and each distorts units in the same direction across thousands of visits. Commercial payers add their own unit caps per visit or day, and Medicare reduces payment on additional units through its multiple-procedure reduction — so the right count has to be checked against both the clock and the payer.

The KX threshold: past a point, documentation carries the claim

Medicare no longer applies a hard dollar cap to outpatient therapy, but the structure that replaced it depends entirely on documentation. Once a patient’s therapy spending passes the annual KX threshold, each further claim needs the KX modifier — the practice’s attestation that services remain medically necessary and the record supports continued skilled care. For calendar year 2026, that threshold is $2,480 for physical therapy and speech-language pathology combined, as set by CMS Transmittal R13437CP. Occupational therapy has its own separate $2,480 threshold.

Two consequences follow. First, the threshold has to be tracked per patient, across both disciplines, all year; discovering it only when claims start denying means weeks of services were already billed unattested. Second, the KX modifier is not a formality: it asserts that the chart shows skilled need — functional goals, progress against them, a clinical reason therapy must continue. Claims carrying it can be selected for medical review, where the documentation either proves what the modifier says or it does not.

Plans of care: certification dates are billing deadlines

For Medicare patients, therapy is paid under a certified plan of care. The treating therapist establishes the plan, and a physician or other qualified practitioner certifies it with a signature. Recertification is required at least every 90 days, and sooner whenever the plan is written for a shorter period or the patient’s condition changes enough to alter it. A written progress report is due at least once every 10 treatment days, tracking progress toward the plan’s goals.

None of that is clinical news to a PT practice. The billing consequence is what gets missed: visits delivered under an expired certification sit outside the certified plan, and claims for them can be denied or recouped even when the treatment was appropriate. Late certifications need their own documentation explaining the delay. Across a full caseload, keeping those dates current is a tracking system, not a memory task — and it belongs in the billing workflow, where claim dates can be checked against certification dates before a claim goes out.

What is actually different about billing in Texas

Texas Medicaid has two features that shape therapy billing here. First, most members are enrolled in Medicaid managed care, so the claim usually goes to the member’s managed care organization — and that plan’s authorization and filing rules govern it, not the state’s. Second, fee-for-service claims filed with TMHP, the Texas Medicaid & Healthcare Partnership, carry a 95-day timely filing deadline from the date of service, per the TMHP provider manual. That deadline punishes slow denial follow-up: a claim denied in its second month leaves little room to correct and refile.

Those rules sit inside the broader Texas picture covered on our medical billing services in Texas page. Around that insurance core, most Texas PT practices carry two streams that never behave like normal claims: workers’ compensation cases, which follow the carrier’s authorization and documentation process and stall when nobody owns the follow-up, and cash-pay visits, which never become claims at all and so drift out of the billing workflow. Keeping both visible alongside insurance receivables is part of a clean revenue cycle.

How Fastora works a Texas PT practice’s billing

This page is the Texas layer of our physical therapy billing services — the same discipline we apply to therapy billing nationally, worked against Texas payers and Texas deadlines:

• Eligibility and authorization checks. Coverage, visit limits, and authorization requirements are confirmed up front, and visit counts tracked against plan limits, so a capped benefit is never discovered at the twenty-fifth visit.
• Charge and unit review. Treatment minutes are reconciled against billed units before claims go out, so the 8-minute rule is applied to the day’s totals, not guessed at code by code.
• Threshold and certification tracking. KX thresholds are monitored per patient across the shared PT and speech total, and certification dates are tracked so claims never run ahead of the paperwork.
• Denial management and appeals. Denials are worked by root cause — unit errors, authorization gaps, documentation requests — and corrected claims refiled inside the applicable deadline, including TMHP’s 95-day window. Aged claims are followed up systematically by payer and age.
• Payment posting and underpayment review. Remittances are posted and compared against contracted rates; therapy paid a few dollars short per unit only becomes visible when someone reconciles at the unit level.

Many Texas therapy practices bill more than PT under one roof. The same workflows extend to occupational and speech therapy through our rehabilitation billing services — which matters for the KX threshold alone, since PT and speech accumulate against the same $2,480 total.

Fastora brings 5+ years of medical billing experience to this work, supports 50+ active clients, and has worked with 100+ satisfied MDs. Pricing is straightforward: billing services are charged either as a percentage of collections or as a flat monthly fee, depending on what fits your practice.

PT practices across Texas

We support physical therapy practices throughout the state, including the Houston, Dallas–Fort Worth, Austin, and San Antonio metros and practices in El Paso, the Rio Grande Valley, and Lubbock. Most run lean front desks, where the same person checks patients in, verifies benefits, and posts payments — which is why certification tracking and denial follow-up slip first, and why we take them over.

Frequently asked questions

How does the 8-minute rule actually work?

Add up the day’s timed treatment minutes and bill units from that total: 8–22 minutes is one unit, 23–37 is two, 38–52 is three, and so on. A timed service under 8 minutes earns no unit on its own, but its minutes still count toward the day’s total. Untimed codes, like an evaluation, sit outside the rule and are billed once a day.

What is the KX threshold for 2026, and what happens when a patient passes it?

For 2026, the threshold is $2,480 for physical therapy and speech-language pathology combined, per CMS Transmittal R13437CP; occupational therapy has its own separate $2,480 threshold. Passing it does not cut off coverage: claims continue with the KX modifier attached, attesting the services remain medically necessary — and the documentation has to back that up, because claims above the threshold can be chosen for medical review.

What is the filing deadline for a Texas Medicaid PT claim?

Fee-for-service Texas Medicaid claims filed with TMHP must be submitted within 95 days of the date of service. In practice, though, most members are in Medicaid managed care, so most claims go to the member’s MCO under that plan’s filing rules. Knowing which route each patient takes is what keeps the 95-day window from becoming a write-off.

How often does a plan of care need to be recertified?

Under Medicare, at least every 90 days — and sooner if the plan was certified for a shorter period or the patient’s condition changes significantly. The recertification needs the practitioner’s signature, just like the initial certification. Claims billed for visits after a certification has lapsed are exposed to denial or recoupment, which is why we track certification dates in the billing workflow, not on the clinical calendar.

How much do your billing services cost, and can you take over only part of the work?

Fastora charges either a percentage of collections or a flat monthly fee. Yes — many practices keep claim submission in-house and hand us the parts that fall behind, such as certification tracking, denial management, or aged A/R. The free billing audit is the easiest way to see which parts those are for your practice.

Start with a free billing audit

If your Texas PT practice is losing revenue to unit errors, expired certifications, or claims aging against short filing windows, the clearest next step is a free initial billing audit: we review how your claims are performing, where the preventable losses are, and what fixing them takes — no obligation. Request your free initial billing audit and we will take it from there.