Rehab therapy billing services for multi-discipline clinics
Fastora provides rehab therapy billing services for outpatient clinics that offer physical, occupational and speech therapy under one roof, and for physiatry groups that pair PM&R medical billing with in-house therapy. Each discipline follows its own codes, modifier and plan of care, yet the claims all draw on the same patient benefits, so one mistake on one side can affect the others.
A single patient often moves across disciplines. After a stroke, a patient may see PT for gait, OT for self-care and SLP for swallowing in the same week, each under a separate plan of care, while the physiatrist manages the overall course. The claims have to agree on diagnosis and dates, and every visit draws down a benefit that may be pooled.
Our therapy billing services cover eligibility and benefits, authorizations, charge review, our Advanced Pre-Submission Claim Review before electronic submission, payment posting, denials and AR. Every claim is handled by certified medical billing and coding professionals.
Rehabilitation billing rules shared by PT, OT and SLP
Under Medicare, outpatient therapy is paid only under a written plan of care certified by a physician or nonphysician practitioner, with recertification and progress reports on a schedule. Each discipline needs its own plan and its own modifier, and Medicare tracks spending against two annual per-beneficiary thresholds. CMS publishes the threshold amounts each year; above them, lines need the KX modifier and records that support medical necessity.
| Discipline | Medicare modifier | Evaluation codes | Medicare threshold | Main unit logic |
|---|---|---|---|---|
| Physical therapy | GP | 97161-97163 (re-eval 97164) | Shared with SLP | Mostly timed, 15-minute units |
| Occupational therapy | GO | 97165-97167 (re-eval 97168) | Separate OT threshold | Mostly timed, 15-minute units |
| Speech-language pathology | GN | 92521-92524, 92610 | Shared with PT | Mostly untimed, per session |
Timed codes follow the 8-minute rule for Medicare, counted across all timed minutes in a visit, while many SLP codes are billed once per session. Shared codes such as 97530 or 97110 can be billed by PT or OT, and only the modifier and plan of care tell the payer which benefit the line counts against. Assistant services carry CQ (PTA) or CO (OTA) for Medicare and are paid at a reduced rate.
PT, OT and SLP billing services by discipline
This page is the hub for our rehab work. Each discipline has its own page with code tables, documentation points and payer rules:
- Physical therapy billing: evaluation tiers, timed units, GP, KX and CQ modifiers, plan-of-care dates and workers' comp.
- Occupational therapy claims: evaluation codes 97165-97168, self-care training, the GO modifier and pediatric Medicaid.
- Speech-language pathology billing: untimed codes such as 92507 and 92526, the GN modifier and pediatric authorizations.
Clinics that bill all three under one tax ID benefit most from a single team that sees the whole patient, because pooled limits and the combined PT/SLP threshold only show up when the disciplines are viewed together.
Outpatient rehab billing: pooled limits and same-day visits
Commercial plans often pool rehab visits across disciplines, sometimes with chiropractic care in the same count. When a patient sees PT and OT on the same day, some plans count two visits and some count one. We check how each plan counts before the schedule is built, so a patient does not reach the limit halfway through an episode.
- Visits used at other providers earlier in the year are confirmed with the payer, since commercial limits and the Medicare thresholds follow the patient.
- Evaluations by two disciplines on the same day are both billable when each has its own plan of care and documentation.
- Same-day services carry the correct discipline modifier on every line, and NCCI pairs get modifier 59 or an X modifier only when the record shows distinct services.
- Rehabilitative and habilitative benefits are checked separately, since some plans pay one but limit the other.
PM&R medical billing for physiatrists
Physiatrists bill new and established patient E/M visits, with the level supported by medical decision-making or total time on the date of the encounter. Consultation requests from other physicians are billed as office visits for Medicare, while some commercial payers still accept consultation codes. When a separately identifiable E/M service happens on the same day as a minor procedure such as an injection, modifier 25 is added to the E/M only when the note documents work beyond the procedure's usual pre-service evaluation.
| Code | Descriptor (summary) | Notes |
|---|---|---|
| 95907–95913 | Nerve conduction studies, by number of studies (95907 for 1–2 studies through 95913 for 13 or more) | Count each nerve and study type as the code set defines |
| 95886 | Needle electromyography, each extremity, with related paraspinal areas, done with nerve conduction studies; complete | Add-on code reported with the nerve conduction code |
| 20552 | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) | Billed once per session |
| 20553 | Injection(s); single or multiple trigger point(s), 3 or more muscles | Billed once per session |
| 20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidance | Drug supply billed separately with its HCPCS code |
Nerve conduction codes are selected by the total number of studies performed, not by the number of limbs, and the report must list each nerve and study. Medicare Administrative Contractors publish local coverage determinations for nerve conduction studies and EMG, with limits on the number of studies expected per diagnosis. If a technician performs the test, professional and technical components are billed separately with modifiers 26 and TC. Practices with interventional work can also see our pain management billing page.
Sports rehab billing, workers' comp and injury payers
Sports rehabilitation billing often involves payers other than the patient's health plan. Workers' compensation claims need the employer, date of injury, claim number and adjuster approval, and are paid under state fee schedules. Auto and personal injury protection (PIP) claims follow state rules and policy limits, and the health plan may deny until auto coverage is exhausted or documented.
In Texas, workers' compensation rules at 28 Texas Administrative Code §134.600 list physical and occupational therapy among services that need preauthorization, with an exemption for the first six visits after the evaluation when they occur within two weeks of the date of injury or of a surgery the carrier preauthorized. Other states set their own rules, so we check them claim by claim.
External cause and activity diagnosis codes help payers route injury claims correctly. For athletes treated by team physicians and orthopedic surgeons, see our orthopedic and sports medicine billing page.
Authorizations, denials and AR across rehab services
Authorization needs differ by service line. Therapy visits may need approval after the evaluation, electrodiagnostic tests and injections may need approval under the payer's policy, and workers' compensation often requires adjuster sign-off before treatment. Our authorization team tracks approvals by discipline, visits and dates.
Typical rehab denials include missing discipline modifiers, therapy visits beyond pooled limits, lines above a Medicare threshold without KX, nerve conduction counts that do not match the report, modifier 25 without separate documentation, and injury claims sent to the wrong payer. Each denial is traced to its cause, corrected and appealed with the supporting record.
AR is worked by payer and age, with extra attention to workers' compensation and PIP claims, which often need adjuster calls and resubmission with medical records. When an auto carrier denies because benefits are exhausted, we move the claim to the health plan with the carrier's exhaustion letter rather than writing it off.
Credentialing physiatrists, therapists and assistants
A rehab group may need physicians, therapists and assistants enrolled with the same payers under one group. Each clinician needs an NPI, license and payer enrollment, and therapists in private practice enroll with Medicare individually and reassign benefits to the group. Assistant services are billed under the supervising therapist with CQ or CO for Medicare where applicable. Our credentialing and enrollment team tracks every application through a nine-stage process until the clinician is ready to bill.
What to look for in a billing partner
Our Virtual Assistant team verifies benefits, pooled visit limits, injury claim details and authorizations before care. Scriber support records documentation in your EHR in real time. Certified billers code physician and therapy services, submit claims, post payments, and work denials and AR, all inside your existing EHR/PM system with no software to install.
You get a dedicated account contact, transparent dashboards and a monthly review call. When you compare rehabilitation billing services, ask how each team tracks the two Medicare thresholds, pooled visits and plan-of-care dates across disciplines. Pricing is quoted after a free assessment, as our pricing page explains. Groups that also run counseling or neuropsychology services can review our behavioral health billing.
Rehab billing services and rehab therapy RCM
Rehab billing services have to handle timed codes, units and the visit-limit rules that govern therapy benefits — across physical, occupational and speech therapy, often under one roof. Our rehab therapy RCM covers the full cycle for therapy providers: authorizations tracked by visit count, the KX modifier applied where the cap exception applies, claims matched to documented units and denials worked the week they arrive. See our medical billing services for the full scope.
The discipline-specific pages describe each therapy coding in detail. See our physical therapy billing and occupational therapy billing pages.