Billing for independent PT clinics
Physical therapy billing services that count every minute
ePT Billing takes claim submission, EOB posting, denial appeals and A/R follow-up off your clinic's plate, working in the software you already use. The fee is 4.75% of collections, with no startup fees, no long-term contract and a 30-day free trial.
- Medicare and Medicaid claims included
- EOBs posted within 24 hours of scanning
- Denials appealed the day they're processed
8-minute rule check
How many timed units can Medicare pay for this visit?
Medicare adds the minutes of every timed code in the visit, then converts the total. 38 to 52 minutes is 3 units.
| Total timed minutes | Units |
|---|---|
| 8 to 22 | 1 |
| 23 to 37 | 2 |
| 38 to 52 | 3 |
| 53 to 67 | 4 |
Client story
From a PT owner with two locations
Some months go by where we'd have like a 30%, 40% not getting paid for those visits… I think he got us down to a little under 10%.
Before ePT Billing, I used to spend a lot of time and headache with billing. Now I don't.
A physical therapy practice owner with two locations, talking about his ePT biller. Shared with his permission. His practice's numbers. Results vary.
Medicare, 2026
Five Medicare rules every PT clinic bills against
Each comes from CMS, and each one affects whether a claim is paid, how much it pays, or whether it gets reviewed. Here is where they stand for 2026, with the source for every number.
The 8-minute rule
Timed codes such as 97110, 97140 and 97530 are billed in 15-minute units, counted from the total timed minutes in the visit: 8 to 22 minutes is 1 unit, 23 to 37 is 2, and 38 to 52 is 3.
KX modifier at $2,480
The 2026 threshold is $2,480 per patient in Medicare-allowed amounts for PT and speech-language pathology combined. Past it, each claim needs the KX modifier and notes that show medical necessity, or Medicare denies it.
Source: CMS Therapy Services, CY 2026
Targeted review at $3,000
Once a patient's Medicare-allowed therapy amounts for the year pass $3,000, their claims can be selected for medical review. CMS holds that figure at $3,000 until 2028.
Source: CMS Therapy Services
CQ modifier pays 85%
Services furnished in whole or in part by a physical therapist assistant carry the CQ modifier, paired with GP, and Medicare pays 85% of the otherwise applicable fee schedule amount.
Source: CMS Therapy Services
GP modifier and progress reports
Services under a PT plan of care carry the GP modifier, and the therapist writes a progress report at least once every 10 treatment days.
How this shows up in our work: claims are audited daily before submission, so clerical misses like a missing modifier can be caught before the payer sees them. For codes, modifiers and the documentation checklist, read our physical therapy billing guide.
What we handle
What ePT takes off your front desk
Daily claim audits
Primary and secondary claims are audited every day before submission, working from the digital claims system your clinic already runs.
EOBs posted in 24 hours
Insurance payments and contract adjustments land on patient ledgers within 24 hours of your office scanning the EOBs.
Same-day appeals
Each denial is examined and appealed the day it is processed, and we keep you posted on where it stands.
Weekly A/R follow-up
Insurance balances more than 30 days past due get followed up every week, not when someone finds the time.
Reports you can use
A daily email shows what was worked that day. Each month you get a detailed analysis of your insurance aging report.
No orphan visits
Procedures that never made it onto a claim are batched daily, so fewer visits slip through unbilled.
4.75%of collections
- No startup fees
- Month-to-month, no long-term contract
- 30 days free to try us
Wondering how that compares with a salaried biller? The PT billing cost calculator runs the math with your own numbers.
Free tools and guides
Built for PT owners who bill
Use them whether or not you ever hire us. Every one is written for physical therapy clinics, not medical billing in general.
8-minute rule calculator
Medicare units next to CPT midpoint units, with worked examples.
Open toolPT billing cost calculator
A percentage fee against an in-house biller's wages and overhead.
Open toolPT denial codes
What CO-4, CO-50, CO-119 and CO-197 mean, and the fix for each.
Read guideTop 10 denial reasons
Why PT claims get rejected and when to resubmit, reopen or appeal.
Read guidePT billing basics
Timed and untimed codes, modifiers and Medicare documentation.
Read guideRecoupments
Six ways payers take money back, and how to answer each one.
Read guideHiring a PT biller?
12 questions to ask any billing company before you sign, us included.
Get checklist50 PT billing tips
Eligibility checks, 8-minute rule units, claims, appeals and A/R follow-up.
Read guideSwitching
Three steps to hand off your billing
- Step 1
A 15-minute call
Tell Alex how billing runs today, which software you use and where claims stall. You'll get a straight answer on whether outsourcing fits your clinic.
- Step 2
Set up in your system
We agree on a secure way to share patient and billing information, then start working in your existing claims software.
- Step 3
Daily claim work
Charges are entered and claims audited before submission, EOBs are posted within 24 hours of scanning, and a summary email arrives each day.
FAQ
PT billing questions, answered
Something else on your mind? Call 424-442-0509, Monday to Friday, 9am to 5pm Pacific.
How much does ePT Billing cost?
4.75% of collections. There are no startup fees, service runs month to month, and the first 30 days are a free trial.
Do we have to change our EMR or billing software?
No. We work inside the digital claims system you already use.
Do you bill Medicare and Medicaid?
Yes. Medicare and Medicaid claims are part of the work we do for physical therapy practices.
What is the KX modifier threshold for 2026?
$2,480 for physical therapy and speech-language pathology combined. Once a patient's Medicare-allowed therapy amounts for the year pass it, claims need the KX modifier to confirm the care is medically necessary. Above $3,000, claims can be picked for targeted medical review.
How does the 8-minute rule work?
Medicare adds up the minutes of every timed service in the visit, then bills one 15-minute unit for 8 to 22 minutes, two units for 23 to 37, three for 38 to 52, and so on. Our free calculator shows the count and compares it with the CPT midpoint rule some commercial payers use.
What happens when a claim is denied?
We examine the denial, appeal it the same day it is processed and keep following up, so you always know where it stands.
Talk through your PT billing in 15 minutes
Bring your numbers or just your questions. If ePT isn't the right fit for your clinic, you'll hear that on the call.
Pick a time with Alexalex@eptbilling.com
Monday to Friday, 9am to 5pm Pacific
2300 W Sahara Ave, Ste 800, Las Vegas, NV 89102