THE BOTTOM LINE
PT billing runs on minutes and signatures. Get the minutes right and the plan of care signed on time, and most of the rest follows.
The three things that generate the most preventable denials: units calculated from per-code time instead of pooled timed minutes, plans of care that are unsigned, undated, or out of period, and the KX modifier missing on claims after a patient crosses the annual threshold.
One thing worth knowing before you read further: the plan of care certification rules changed for dates of service on or after January 1, 2025, and a lot of practices are still running the old workflow. That section is below.
What the full playbook covers
Solo subscribers read the full playbook. Here is what it contains.
- Definitions and frequently used terms
- Timed and untimed codes, and why the distinction is the whole game
- The 8-minute rule
- The KX threshold
- Plan of care certification, including the rule that changed in 2025
- NCCI edits, and an honest note about the 97140 pairs
- MPPR, because it is quietly reducing your payment
- Modifiers you have to get right
- The denial patterns you will actually see
- Documentation and workflow that holds up
- Frequently asked questions
- How we work on this at ROI
- Two things to verify in your own practice this week
- Sources