Physical Therapy Billing Units A Guide to Maximizing Reimbursements

A professional give the physical therapy servies to patient and note the Physical Therapy Billing Units

Key Takeaways

  • Physical therapy billing units are calculated based on time and payer rules (Medicare uses the 8-minute rule; private insurers may differ).
  • Documentation is critical, including start/stop times, CPT codes, and measurable outcomes to justify claims.
  • Always verify payer-specific guidelines (Medicare, Medicaid, BCBS, private insurance) before billing.
  • Use correct modifiers (GP, -59, KX when needed) to avoid claim rejections.
  • Regular audits and staff training help reduce denials and protect revenue.

Navigating physical therapy billing units can feel overwhelming, especially with Medicare, Medicaid, BCBS, and private insurers each enforcing slightly different rules. Missteps lead to denied claims, delayed payments, or under-billing that leaves money on the table. This 2025 guide will break down:

What Are Physical Therapy Billing Units?

Physical therapy billing units determine how providers charge for timed services like therapeutic exercise, manual therapy, or neuromuscular re-education. Most CPT codes for PT are billed in 15-minute increments (per unit). However, payers interpret those minutes differently.

  • Medicare units: Based on the 8-minute rule
  • Medicaid & BCBS: Often follow Medicare’s rules but may add restrictions
  • Private insurance units: Some use strict 15-minute units without rounding

In short: PT billing units = time + payer-specific rules.

Physical Therapy Billing Units by Payer

  • Medicare PT Billing Units

    • Uses the 8-minute rule.
    • Maximum of 4 units per day unless medical necessity is documented.
    • Requires precise documentation of time and activities performed.

    BCBS (Blue Cross Blue Shield)

    • Often follows the 8-minute rule.
    • May require modifier -59 when billing multiple services like 97110 + 97140.
    • Prior authorization may be required after 12 units per month.

    Private Insurance

    • United Healthcare: Uses strict 15-minute increments (no rounding).
    • Aetna: 8-minute rule applies, but some codes (like e-stim) may be bundled.
    • Other carriers: Policies varyβ€”always check the contract.

    Medicaid Billing Units

    • Many states follow Medicare’s 8-minute rule.
    • Some states cap total monthly PT units.
    • Always confirm with state-specific Medicaid guidelines.

Common CPT Codes for PT Billing Units

  • 97110: Therapeutic Exercise (per 15 minutes)
  • 97140: Manual Therapy Techniques
  • 97530: Therapeutic Activities
  • 97112: Neuromuscular Re-education
  • G0283: Electrical stimulation, unattended

Need Help with Medical Billing?

Fill out the form below and we’ll contact you shortly.

Thank you! Your message has been sent.

Let's Talk

+1 (917) 994-9941

3811 Ditmars Blvd# 1124,

Astoria, NY 11105

5 Steps to Avoid Denials in PT Billing

  • Track Minutes Precisely – Use EHR timers or apps to log sessions in real time.
  • Document Everything – Start/stop times, exercises, and patient progress (not vague notes).
  • Know Your Payer Rules – Don’t assume Medicare, Medicaid, and private insurance follow the same unit calculations.
  • Use Correct Modifiers – Medicare requires GP; BCBS often needs -59.
  • Audit Claims Monthly – Spot under-coding, over-coding, and recurring denial patterns.

5 Steps to Avoid Denials in PT Billing

Becoming skilled at physical therapy billing units is the key to maximizing reimbursement while staying compliant with Medicare’s 8-minute rule and private payer guidelines. A single coding mistake can trigger denials or audits, costing your practice thousands.

Pro Tip: Train your staff quarterly on PT billing unit guidelines and run internal audits to catch mistakes early.

Struggling with PT billing units or therapy billing denials? Let Cures Medical Billing handle the complex rules so you can focus on patient care. Contact us today for a free billing review.

Frequently Asked Questions (FAQs)

The 8-minute rule is a Medicare guideline that allows therapists to bill 1 unit of service for at least 8 minutes of a timed CPT code. For example, 23–37 minutes = 2 units, 38–52 minutes = 3 units, etc.

Billing units are calculated by dividing the total timed minutes of a session by 15 (the standard CPT unit). Medicare applies the 8-minute rule, while private insurers may use strict 15-minute increments or variations.

Yes, but you must document each service separately and use modifiers (e.g., -59 for distinct procedures) to avoid denials. Medicare, Medicaid, and private payers all have limits on daily or monthly PT units.

  • 97110 – Therapeutic exercise
  • 97140 – Manual therapy
  • 97530 – Therapeutic activities
  • 97112 – Neuromuscular re-education

Not always. Some follow the Medicare 8-minute rule, while others require strict 15-minute increments without rounding. Always check the payer’s guidelines.

Yes, but you must clearly document each service and use proper modifiers (e.g., -59) to prevent denials.

Discover Cures Medical Billing Services Across Different States

Your Success Is Our Success

We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.

Start free 30 Days Trial Now

Contact Our RCM

Β© 2024 Created Cures Medical Billing Solutions, All copyrights ReservedΒ 

Wait! Before You Leave – Get a Free Billing Audit & Save Up to 20% of Your Revenue.

βœ… Thank you! Your information has been submitted.

βœ… Your request has been sent successfully!
×
Icon

Get a FREE Medical Billing Audit

×

Book A Free Medical Billing Audit