The healthcare industry is governed by its own set of rules and regulations. For instance, based on the Medicare Conditions of Participation, hospitals have to retain records for five years. When it comes to physical therapy medical billing to be more specific, there are also Medicare guidelines that need to be followed to ensure you’re reimbursed for claims successfully. Below you’ll find the most crucial physical therapy medical billing rules to follow.

The 8-Minute rule

This rule specifies that treatment needs to be provided directly for at least eight minutes before Medicare can reimburse you for a time-based code. While this sounds simple enough, it’s best to explore all related scenarios to ensure you don’t overlook anything that might cost you.

Proper Credentialing

If you’re not credentialed, this can affect you because you won’t be able to treat or receive pay that covers Medicare patients. To get credentialed, you’ll need a state license to practice physical therapy as well as a suitable practice location, malpractice insurance, and an NPI.

One on One Vs Group Therapy

It’s important to distinguish between one on one therapy (individual therapy) vs group therapy, which typically involves combining procedures for two or more patients. The CPT codes for these two alternatives vary and knowing which is which reduces errors when it’s time to bill.

Therapy Cap

This rule places a limit on the number of physical therapy services you provide to your clients per year. If you feel the client requires medical attention, you can apply for an exemption after they have exceeded their cap.


An Advance Beneficiary Notice of Noncoverage (ABN) is a document that’s signed by Medicare and your patient after you provide them with services that are either not covered or deemed to be medically unnecessary. By signing, the patient agrees to cover the payment if the claim is denied.

Use the Right Codes

Whether it’s ICD10 Codes or CPT-4 codes, you need to use the proper codes when submitting claims related to your physical therapy medical billing. Be sure to know all the common codes so you get reimbursed on the first try without having to appeal.

Billing is a fact of life if you’re a physical therapist with your own practice. However, it doesn’t have to be a stressful hassle if you take the time to carefully review the information in this article.