What are PT billing units and why are they important

1. What are PT billing units and why are they important? Billing is often considered the least exciting aspect of running a physical therapy practice. However, optimal billing practices are important for the financial health and growth of a PT business. Understanding PT billing units can have a major positive impact. PT Billing units are attached to Current Procedural Terminology (CPT) codes that therapists select to describe the physical therapy service or intervention performed. Most PT CPT codes bill based on timed 15-minute units. The number of units that can be billed depends on payer rules regarding how many minutes must be performed before a unit can be counted. Medicare’s 8-Minute Rule Medicare created specific guidance referred to as the “8-minute rule” to determine what qualifies as a billable unit. While originally intended for Medicare plans, the rule has been adopted by many other insurers like Medicaid and commercial plans. According to the rule, at least 8 minutes of hands-on treatment must be performed before one 15-minute unit can be billed. An additional unit can be billed only after a total of 23 minutes, and a third unit after 38 minutes. See the chart below to get a more understanding. 8 – 22 minutes = 1 unit

2. 23 – 37 minutes = 2 units 38 – 52 minutes = 3 units 53 – 67 minutes = 4 units Understanding this rule and properly counting treatment minutes is key for accurate billing. Count only active treatment minutes rather than total time the patient is with the therapist. Document minutes for each intervention performed and total for the visit. Billing Scenarios Consider these billing scenarios: 1.If a patient receives 24 minutes of neuromuscular reeducation and 15 minutes of therapeutic exercise, the total countable minutes are 39. This qualifies for 2 billable units. 2.If a patient receives 23 minutes of therapeutic exercise and 17 minutes of neuromuscular reeducation for 40 total minutes, this still only qualifies for 2 billable units. The total minutes falls in the 23 – 37 minute tier. 3.If a patient receives 35 minutes of therapeutic exercise, 30 minutes of unattended electrical stimulation, and 12 minutes of neuromuscular reeducation, special rules apply. The unattended e-stim counts as 1 unit regardless of minutes. Total timed minutes are 47, which counts as 3 units. Plus, the 1 e-stim unit totals 4 billable units. Why do PT Billing Units Matter Carefully tracking treatment minutes and billing units enables a practice to maximize reimbursement under insurance rules. This directly impacts revenue and profitability. Billing the maximum allowable units results in higher collections per patient visit. Under-billing due to unclear documentation or unfamiliarity with billing protocols leads to lost revenue over time. Billing units also provide useful metrics. Monitoring the average number of units per patient visit helps set productivity goals and identify potential documentation issues for correction. While delivering excellent patient care remains the priority, closely managing billing units and understanding payer rules play an equally vital role in operating a financially successful PT practice. Optimizing this aspect of operations allows therapists to focus on providing quality treatment while ensuring the business remains viable. Use the Right Platform In the end, optimal PT billing unit practices serve to maximize reimbursement from insurance companies within their complex guidelines. However, inaccuracies still creep in during hectic patient schedules leading to denied claims and lost revenue. This is why many practices partner with integrated platforms which combine electronic medical records with full-service billing teams. Reimbursement rates consistently reach 99% by

3. leveraging automation and billing expertise to ensure accurate claims the first time. This leaves therapists free to deliver best-in-class care while ensuring the financial health of their practice.