Physical Therapy Medical Billing Guidelines - Medical Billing Guidelines

Physical therapists have a lot on their hands.

Besides providing quality patient care, many physicians play an active role in the medical billing process of their practice. Especially true for smaller practices where physicians are not able to afford a specialized billing team.

The Problem?

Physical therapists can spend as much as 14 hours a week in billing related activities. For many, it is simply not possible.

All this time can be invested in seeing more patients, bringing more revenue and growing the practice.

On the other hand, billing is pivotal for the growth of the practice. All the time spent with patients is in vain if physicians do not get reimbursed on time.

Add to it the complexities dealing with various medical payers, things can get tough.

Medicare Billing

Billable Time of Treatment:

The time spent while treating a patient is called as billable time. However, there are some things to keep in mind while billing:

•              Unskilled preparation time

•              Multiple time units due to multiple therapists

•              Rest periods or break times

•              Supervision, and

•              Documentation.

While calculating the billable time, it should not be rounded up. Evaluations and Re-evaluations can be billed in some special cases.

Physical Therapy Medical billing guidelines for Medicare allows billing for initial evaluations that are necessary to set up a plan of care. While re-evaluations can be billed for the time spent on mid-episode assessments only if there is significant progress in the patient’s health condition.

One-on-One vs. Group Services

Billing for the time of treatment depends upon the nature of services i,e. one-on-one or in groups. While one-on-one services involve direct or face-to-face contact with the patient, a group service requires constant attendance while not requiring a face to face contact.

Rather, as per the physical therapy medical billing guidelines for Medicare, a group service can be a simultaneous treatment episode of two or more patients who may or may not be undergoing the same kind of treatment.


There are chances that the same service or treatment is provided by multiple therapists at one time. As per the physical therapy medical billing guidelines for Medicare Part B, a therapist cannot bill for the same or different services at the same time.

However, for Medicare Part A, they may bill separate and full treatment sessions with a patient as long as the therapist belongs to a different specialty.


Being in a network with the insurance companies help you reach and serve a larger pool of patients. Physical Therapy Medical Billing Guidelines for Medicare do not allow an un-credentialed therapist to provide services and obtain payments for the same.

Patient Responsibilities

Some insurances require patients to pay a sum of the amount called Co-Payment or Deductible amount before they start to pay out for services. You can collect the same while offering your services to them. You may want to provide financial assistance to your patients, but there are other ways to do that.

Advanced Beneficiary Notice (ABN)

An ABN is an advanced notice or document stating who will be the beneficiary for any reimbursements and responsible for any rejections or non-payments. In cases when you feel that services are not covered by Medicare or they are not medically necessary, an ABN of non-coverage must be signed to determine the person responsible for making the payment.

Bikham Healthcare is a leading provider of medical billing solutions to medical practices of all sizes. They are 100% HIPAA compliant and have sound knowledge of physical therapy medical billing guidelines for Medicare and other major payers.

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