Physical Therapy Billing Services
Physical therapy billing is entirely time-based with the 8-minute rule governing unit calculation. Add authorization tracking, functional reporting requirements (G-codes), and the therapy cap, and PT billing becomes one of the most rules-heavy specialties.
Why Physical Therapy Billing Requires Specialty Expertise
PT billing uses timed CPT codes (97110, 97140, 97530, 97542) with the 8-minute rule determining how many units can be billed per service. Untimed codes (97012-97028) don't follow the same rules. CMS functional reporting requirements and authorization tracking add additional complexity.
Common Physical Therapy CPT Codes
Our coders handle these physical therapy codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Physical Therapy CPT Codes by State
Medicare reimbursement for physical therapyprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same physical therapy CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 10 core physical therapycodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Physical Therapy Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 97161 | Physical therapy evaluation, low complexity | $108.00 | $97.41 | $98.33 | $105.75 | $97.41 | $96.80 | $93.86 | $95.88 | $94.66 | $95.19 |
| 97162 | Physical therapy evaluation, moderate complexity | $108.00 | $97.41 | $98.33 | $105.75 | $97.41 | $96.80 | $93.86 | $95.88 | $94.66 | $95.19 |
| 97163 | Physical therapy evaluation, high complexity | $108.00 | $97.41 | $98.33 | $105.75 | $97.41 | $96.80 | $93.86 | $95.88 | $94.66 | $95.19 |
| 97164 | Physical therapy re-evaluation | $74.89 | $67.08 | $67.90 | $73.16 | $67.06 | $66.70 | $64.42 | $65.97 | $65.00 | $65.47 |
| 97110 | Therapeutic exercise, 15 minutes | $31.95 | $28.91 | $29.42 | $31.47 | $28.94 | $28.95 | $27.87 | $28.52 | $28.02 | $28.36 |
| 97140 | Manual therapy techniques, 15 minutes | $30.47 | $27.58 | $28.08 | $30.03 | $27.61 | $27.64 | $26.59 | $27.21 | $26.73 | $27.06 |
| 97112 | Neuromuscular reeducation, 15 minutes | $36.06 | $32.56 | $33.10 | $35.46 | $32.59 | $32.57 | $31.37 | $32.10 | $31.56 | $31.91 |
| 97530 | Therapeutic activities, 15 minutes | $39.12 | $34.82 | $35.45 | $38.21 | $34.81 | $34.75 | $33.33 | $34.23 | $33.61 | $33.98 |
| 97035 | Ultrasound therapy, 15 minutes | $15.75 | $14.27 | $14.70 | $15.62 | $14.30 | $14.46 | $13.75 | $14.12 | $13.77 | $14.07 |
| 97014 | Electrical stimulation, unattended | $13.92 | $12.60 | $13.03 | $13.83 | $12.64 | $12.80 | $12.14 | $12.48 | $12.15 | $12.44 |
Full Physical Therapy fee detail by state
2026 Medicare allowables for physical therapy CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 97161 | Physical therapy evaluation, low complexity | $108.00 | $108.00 |
| 97162 | Physical therapy evaluation, moderate complexity | $108.00 | $108.00 |
| 97163 | Physical therapy evaluation, high complexity | $108.00 | $108.00 |
| 97164 | Physical therapy re-evaluation | $74.89 | $74.89 |
| 97110 | Therapeutic exercise, 15 minutes | $31.95 | $31.95 |
| 97140 | Manual therapy techniques, 15 minutes | $30.47 | $30.47 |
| 97112 | Neuromuscular reeducation, 15 minutes | $36.06 | $36.06 |
| 97530 | Therapeutic activities, 15 minutes | $39.12 | $39.12 |
| 97035 | Ultrasound therapy, 15 minutes | $15.75 | $15.75 |
| 97014 | Electrical stimulation, unattended | $13.92 | $13.92 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Physical Therapy Billing Challenges We Solve
Common billing problems in physical therapy and how our team handles them.
8-Minute Rule
Unit calculation based on total direct treatment time. Errors in either direction affect revenue or compliance.
Authorization Tracking
Most payers limit visits per authorization period. Missing re-auth means unpaid visits.
Timed vs Untimed Codes
Timed codes follow the 8-minute rule. Untimed codes (modalities) don't. Mixing them up causes errors.
Medicare Therapy Cap
Threshold amounts trigger manual review. KX modifier and documentation requirements.
Common Physical Therapy Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Physical Therapy Practices Miss
Payer-Specific Physical Therapy Billing Tips
Physical Therapy Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Physical Therapy Billing Support
Free billing assessment for your physical therapy practice. See where revenue is leaking.
What We Handle for Physical Therapy Practices
Why Choose Go Medical Billing for Physical Therapy
PT billing errors center on the 8-minute rule and authorization management. Our team handles both with precision, ensuring every unit is correctly calculated and every authorization is tracked.
We serve physical therapy practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Physical Therapy Billing by State
We handle physical therapy billing in all 50 states. The 2026 Medicare allowables for physical therapy CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Physical Therapy Billing Support
Stop losing revenue to physical therapy coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.