Physical Medicine and Rehabilitation Billing and Coding Services
Hand us the billing. We run the whole revenue cycle, and we charge 5% of what we collect.
Our Services
Treating Without Surgery or Drugs
Physical medicine and rehabilitation treats patients without surgery or medication, and that makes the specialty complicated to bill. Rather than talk about how complicated it is, we would rather show you how we work. We handle every part of physical medicine billing services carefully, to the standards the market expects.
What benefits are provided by our Physical Medicine and Rehabilitation Billing and Coding Services?
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Comprehensive Reach
We do not cut corners on any procedure. Our physical medicine billing services hold the same standard for a simple office visit as for a full rehab course. That standard has held as we have added practices and specialties.
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Structural Optimization
Good billing is more than coding. It is also collecting the money before the filing deadline passes. We work on both. And we work the same way whatever the specialty, so every claim gets the same attention.
Procedures
Coding and billing services for a wide array of physical medicine and rehabilitation procedures
- Soft Tissue Injections
- NCS
- Joint Injections
- EMG
- Spine Injections
- Pain Medications
- Musculoskeletal Ultrasound
- Prosthetics/Orthotics
- Interventional Spinal Therapeutics
- Therapeutic Exercise
- Spasticity Management
What PM&R Billing Involves
Physical medicine and rehabilitation sits across two billing worlds. Physician services have their own E/M and procedure rules. Therapy services are billed in timed units against a plan of care. A biller who understands one and not the other will lose money on whichever half they know less well.
On the physician side that means electrodiagnostic testing with its professional and technical split, joint and trigger point injections with their guidance rules, spasticity management including botulinum toxin with drug wastage reporting, and prosthetic and orthotic prescription.
On the therapy side it means the 8-minute rule, the annual therapy threshold and the KX modifier, the GP, GO and GN discipline modifiers, and plan-of-care certification dates that deny every claim after they lapse.
Inpatient rehabilitation adds another layer entirely, with its own assessment instrument and payment system. Tell us which settings you work in and we will scope it properly.
Related: physical therapy billing services, occupational therapy billing and pain management billing.
The rules that decide a therapy claim
Physical medicine and rehabilitation is paid on units of time and on a plan of care, and both are checked.
Timed codes and the eight minute rule
Timed treatment codes are billed in fifteen minute units, and Medicare counts them by total treatment time rather than by rounding each code on its own. A single unit needs at least eight minutes. Two units need at least twenty three. Practices that round each service separately overbill without meaning to, and it is one of the easiest patterns for a payer to find in a data set.
Untimed codes, such as an evaluation or a supervised modality, are one unit per visit however long they take. Mixing the two counting methods in the same visit is where most errors start.
The plan of care
Therapy is payable under a plan of care that is certified by a physician or qualified practitioner, and recertified on schedule. It is not enough for the plan to exist. It has to name the diagnosis, the long term goals, the type of treatment, the amount, the frequency and the duration. A plan missing the frequency and duration is the single most common reason a therapy record fails review.
The threshold and the KX modifier
There is no hard annual cap on therapy any more, but there is a threshold. Once a patient's therapy spend passes it, continued treatment is payable only when it is medically necessary and the claim carries the KX modifier, which is an attestation that the record supports it. Above a second, higher amount, claims may be selected for targeted medical review.
The mistake is treating KX as a billing switch that unlocks payment. It is a statement about the documentation, and it is the documentation that gets examined.
Separate services on the same day
Some therapy codes are bundled by default and can only be billed together when they were genuinely separate and distinct, with the right modifier and a note that shows it. Applying that modifier as routine practice is one of the clearest audit signals in this specialty.