Florida Physical Therapy Billing Rules: PIP, Medicaid, Workers' Comp, Direct Access

RuleFlorida's no-fault law pays 80% of reasonable medical expenses, up to $10,000 in medical and disability benefits (Fla. Stat. §627.736(1)(a)). Three rules decide whether your PT visits get paid at all:

• The patient's initial care has to happen within 14 days of the crash, from a provider the statute lists, such as an MD or DO, a hospital, emergency transport, or an APRN registered for autonomous practice.
• A PT is paid for follow-up care only on a referral from a provider the statute lists.
• The full $10,000 applies when one of the providers the statute names, such as a physician, physician assistant or APRN, has found an emergency medical condition. If a listed provider decides there wasn't one, reimbursement stops at $2,500.

One more timing quirk. For 30 days after the insurer hears about the crash, it holds $5,000 back for certain emergency and hospital inpatient providers. If the rest of the benefit can't cover your bill, the insurer's payment clock pauses while that reserve is held (§627.736(4)(c)).

RuleThe insurer may limit payment to 80% of a fee cap. For PT, the cap is 200% of the allowable amount under Medicare Part B's participating physicians fee schedule (Fla. Stat. §627.736(5)(a)1). Three details matter:

• The Medicare schedule that counts is the one in effect on 1 March of the "service year", which runs from 1 March to the end of the following February, for the area where you treated (§627.736(5)(a)2).
• That Medicare amount can never be lower than the 2007 Medicare Part B amount (§627.736(5)(a)2).
• The insurer can't apply Medicare's or workers' comp's limits on the number of treatments or other utilization limits. It can use CMS coding policies and payment methods that aren't utilization limits (§627.736(5)(a)3).

When the insurer pays at that limit, you can't bill the patient for more, except coinsurance or amounts past the policy limits (§627.736(5)(a)4). Bills go on a properly completed CMS-1500 (or another standard form the state approves), coded to CPT and HCPCS rules (§627.736(5)(d)).

The deadline is short. Your statement of charges can't include services more than 35 days before its postmark or electronic send date. Send the insurer a notice of initiation of treatment within 21 days of the first visit and the window stretches to 75 days. Miss it and the patient can't be billed for what goes unpaid (§627.736(5)(c)).

Once the insurer has written notice of the claim and its amount, payment is generally overdue after 30 days, and overdue payments bear simple interest (§627.736(4)(b) and (d)).

Florida's 2026 bills to repeal PIP, SB 522 and its House companion HB 769, died in committee on 13 March 2026. All of the above still applies.

Our math, not a published feeFor services from 1 March 2026 through February 2027. The 2026 amount is higher than the 2007 floor in all three areas, so it sets the cap for 97110. Areas from the CMS locality key. 2026: CMS's relative values for 97110 (0.45 work, 0.41 practice expense, 0.01 malpractice) from the CMS 2026 file, times each area's GPCIs from the CMS localities file, times $33.4009. 2007: the January 2007 values in CMS's RVU07A4 file (work 0.45 times the 0.8994 budget neutrality adjustor, rounded to 0.40 as CMS required, practice expense 0.28, malpractice 0.02, 2007 GPCIs, $37.8975). Full fee schedule amounts, before any payment reductions. Other codes can land the other way, so check each one.

RuleOn 18 June 2026 the Department of Financial Services posted the Health Care Provider 2026 Fee Schedule. It takes effect 1 January 2027 and incorporates Medicare's 2026 reimbursement values (DFS notice). Florida law has DFS publish this schedule by 1 July every year (Fla. Stat. §440.13(12)(e)). It replaces the schedule that took effect 1 January 2026 (DFS fee schedules). DFS posts the rates themselves behind a CPT license page, so we don't reprint them here.

RuleDFS's notice covers the fee schedule only. The billing rules sit in the Health Care Provider Reimbursement Manual, 2024 edition, which is still the current edition on DFS's manuals page as of 1 October 2026:

• PT counts as covered treatment only on a health care provider's referral or prescription. The physical medicine plan of care goes on form DWC-25, submitted to the carrier by the physician.
• Physical medicine is paid up to six months after the date of accident, unless documented, objective findings support an exception.
• One visit a day, unless the carrier authorizes more.
• A therapist re-evaluation is paid no more than once every four weeks, when ordered and documented on the DWC-25.
• A therapist's evaluation and a health care provider's evaluation on the same date of service can't both be paid.
• When a PTA provides more than 10% of the total therapy time, the claim needs the HCPCS Level II modifier.
• Keep the authorization trail: the dates you requested and received it, the carrier's name, and the name of the person who authorized it. Without it, you can be ineligible for payment.

RuleFlorida Medicaid covers PT for recipients 20 and under who aren't in a long-term care plan. Recipients 18 and older in a Long-Term Care plan can also receive PT. Other adults 21 and older get limited services tied to wheelchair evaluations and fittings. PT is a minimum covered service for every Managed Medical Assistance and Long-Term Care plan (AHCA, Therapy Services - Physical).

For fee-for-service patients, prior authorization goes through eQHealth Solutions. Patients in a managed care plan get their authorization from that plan (AHCA therapy services).

RuleA Florida PT can treat on a plan of care the PT wrote. If treatment has to run past 30 days for a condition no practitioner of record has assessed, a practitioner of record must review and sign the plan. That doesn't apply when a physician licensed in another state has examined the patient and diagnosed a condition that needs PT (Fla. Stat. §486.021(11)(a)).

Our readingDirect access doesn't carry over to PIP or workers' comp. PIP pays a PT on a listed provider's referral, and comp covers PT on a referral or prescription.

Yes, if the patient's initial care came within 14 days of the crash from a provider the statute lists, and the PT treats on a referral from one of them. If a listed provider finds no emergency medical condition, reimbursement is capped at $2,500 (Fla. Stat. §627.736(1)(a)).

35 days, counted back from the postmark or electronic send date of your statement. If you send the insurer a notice of initiation of treatment within 21 days of the first visit, it's 75 days (§627.736(5)(c)).

Not by borrowing Medicare's or workers' comp's limits. The statute bars insurers from applying those treatment counts or other utilization limits when they use the Medicare-based fee cap. They can still dispute whether care was medically necessary (§627.736(5)(a)3).

A new maximum reimbursement schedule, built on Medicare's 2026 values, replaces the one that took effect 1 January 2026 (DFS notice, 18 June 2026). The notice covers the fee schedule only. The referral, DWC-25 and authorization rules sit in the 2024 Reimbursement Manual, still the current edition as of 1 October 2026.

In limited cases. AHCA covers PT for recipients 20 and under and for adults in a Long-Term Care plan. Other adults 21 and older are limited to wheelchair evaluations and fittings (AHCA).

Yes. Past 30 days, for a condition no practitioner of record has assessed, a practitioner of record has to review and sign the plan of care (Fla. Stat. §486.021(11)(a)).

• Fla. Stat. §627.736 (2026), personal injury protection
• Florida Senate: SB 522 (2026), died in Banking and Insurance and HB 769 (2026), died in Civil Justice & Claims Subcommittee
• Fla. Stat. ch. 486 (2026), physical therapy practice
• Fla. Stat. §440.13 (2026), workers' comp medical services
• DFS Division of Workers' Compensation: notice of 18 June 2026 and fee schedule list
• Florida WC Health Care Provider Reimbursement Manual, 2024 edition, effective 1 January 2025 and DFS reimbursement manuals list
• AHCA: Therapy Services - Physical and therapy services authorization
• CMS: A/B MAC Jurisdiction N and Medicare locality key
• CMS: 2026 GPCIs by locality, 2026 relative values and January 2007 relative value file (RVU07A4)