Rehabilitation billing
PT/OT/SLP units, therapy caps, plan-of-care recertification — a billing flow with a dozen places to leak revenue.
Therapy billing is technical and unforgiving — the difference between a clean rehab biller and a sloppy one is often 15–20% of revenue.
Where revenue leaks
The rehabilitation traps we see most
Patterns we run into across Rehab practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
8-minute rule errors on therapy units
Time-based therapy codes (97110, 97140, 97530, etc.) bill in 15-minute units using the 8-minute rule. Sloppy time documentation underbills units consistently — often 1 unit per visit, which adds up fast.
Therapy threshold (cap) and KX modifier
Medicare therapy threshold ($2,330 PT/SLP combined, $2,330 OT in 2024) requires KX modifier above the threshold to certify medical necessity. Missing the KX above threshold gets the entire claim denied.
Plan-of-care recertification lapses
Plans of care need physician/NPP signature every 90 days for Medicare. A lapsed plan invalidates ALL claims since the lapse — not just future ones.
Functional limitation reporting (where still required by payer)
Some Medicaid managed care plans in Texas still require functional G-codes despite Medicare retiring them. Skip these and the claim denies.
Coding focus
Where our coders specialize
- Therapeutic procedures (97110, 97112, 97140, 97530, 97150)
- Modalities (97014, 97032, 97035, 97039)
- Evaluations (97161/97162/97163 PT, 97165/97166/97167 OT, 92521/92522/92523/92524 SLP)
- Re-evaluations (97164 PT, 97168 OT)
- Group therapy (97150)
- GP/GO/GN therapy modifiers, KX modifier, modifier 59
Texas payer notes
Local rules we navigate every day
- Medicare 8-minute rule documentation is audited by Texas Novitas — must show start/stop times
- Texas Medicaid prior auth required after first 30 visits for most plans
- Workers' comp (DWC) has unique Texas billing requirements — DWC-69 and progress reports
- BCBS TX requires plan of care submission at the start of treatment for many specialty rehab
Rehab KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for rehabilitation.
98%+
8-min rule unit accuracy
100%
POC recert on-time rate
100%
KX modifier compliance
What's your rehabilitation practice leaking?
Get a free Revenue Leakage Analysis customized to Rehab billing patterns. Three specific leaks at your practice, dollar amounts, and exactly how to fix them. 3 business days. No sales pitch.
Other specialties we serve