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Newest guide90837 vs 90834: Billing Therapy Time Without Audits

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Specialty billing

Physical therapy billing services

Physical therapy billing is turning each session’s evaluations and timed treatments into billable units, under the plan of care and the modifiers payers require, so the claim matches the minutes documented.

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Physical therapy

Minutes become units

  1. 8–22 min1 unit
  2. 23–37 min2 units
  3. 38–52 min3 units
  4. 53–67 min4 units
Medicare adds up the timed minutes and bills in 15-minute steps.

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Count a session’s units

Enter the timed minutes from one session. The counter follows Medicare’s 8-minute rule.

8-minute rule counter

Medicare

Timed minutes from one session, by code.

  • 2units
  • 0units
  • 1unit
  • 0units

40 timed minutes3 units to bill

97140 ran under 8 minutes but still gets a unit: it had the most minutes left over once the full units were given out.

Medicare’s rule. Some commercial payers count each code on its own instead, and every line also needs the GP modifier.

Why is PT billing hard?

  • Minutes become units

    Most PT treatment codes are timed, such as therapeutic exercise (97110), neuromuscular re-education (97112), manual therapy (97140) and therapeutic activities (97530). Medicare adds up the timed minutes and bills in 15-minute steps: 8 to 22 minutes is one unit, 23 to 37 is two.

  • The plan of care has deadlines

    Medicare wants the plan of care signed by the physician or NPP within 30 days of the first treatment, recertified at least every 90 days, and a progress report at least every 10 treatment days.

  • Modifiers on every line

    PT services carry the GP modifier, the KX modifier once a patient’s therapy passes Medicare’s yearly threshold, and the CQ modifier when a physical therapist assistant gave the service, which Medicare pays at a reduced rate.

  • Codes that don’t go together

    Pairs such as manual therapy and therapeutic activities trip NCCI edits unless they were done in separate intervals and billed with modifier 59 or an X modifier.

What Beeline handles for physical therapy practices

Further reading

Physical therapy billing questions

What is Medicare’s 8-minute rule?
It is how Medicare turns time into units for timed therapy codes. Add up the minutes of all timed services in the session, then bill one unit for 8 to 22 minutes, two for 23 to 37, three for 38 to 52, and so on in 15-minute steps. A service under 8 minutes can still count toward the total.
What is the KX modifier in physical therapy?
It tells Medicare that therapy above its yearly threshold is still medically necessary, and that the record shows it. Physical therapy and speech therapy share one threshold, occupational therapy has its own, and CMS sets the amount each year.
Do PT services need the GP modifier?
Yes for Medicare, and many other payers ask for it too: GP marks a service given under a physical therapy plan of care. Occupational therapy uses GO and speech-language pathology GN.
How often does Medicare need a progress report?
At least once every 10 treatment days, written by the therapist. It is separate from recertifying the plan of care, which is needed at least every 90 days.

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