Optimize reimbursements for PT practices with specialists who understand timed code billing, the 8-minute rule, KX modifier requirements, Medicare therapy cap management, and functional limitation reporting — so every minute of therapy time is correctly billed.
Physical therapy billing is governed by rules that apply nowhere else in healthcare — the 8-minute rule, timed vs. untimed code distinctions, the KX modifier for Medicare medical necessity, and functional limitation G-codes that must accompany claims at specific intervals. Get any of these wrong and claims are denied or underpaid. RCMAXIS PT billing specialists are trained exclusively in therapy billing rules and keep your practice compliant and fully reimbursed.
CMS's 8-minute rule governs how many units of timed therapeutic procedure codes you can bill per session. We apply the correct number of units based on total direct treatment time, ensuring maximum reimbursement without upcoding — and we document the rationale for each unit billed.
When Medicare therapy spending exceeds the cap threshold, the KX modifier must be appended to certify medical necessity. RCMAXIS tracks each patient's cumulative therapy spending, alerts your clinical team before the threshold is reached, and applies KX modifiers with documentation to prevent claim rejection.
Medicare requires functional limitation G-codes and severity modifiers at evaluation, every 10th visit, and at discharge. Missed G-codes result in automatic claim rejection. RCMAXIS monitors the reporting schedule for every Medicare patient and ensures G-code reporting is never missed.
PT benefits are notoriously complex — visit limits, co-insurance tiers, separate deductibles for outpatient rehab, and network restrictions vary widely by plan. RCMAXIS verifies benefits before each patient's first visit and notifies your front desk of the patient's expected responsibility, reducing collections friction.
Medicare and commercial payers audit PT claims for documentation deficiencies — missing plan of care certifications, non-compliant progress notes, or unsigned daily notes are common reasons for retroactive denials. Our billing team reviews documentation against billing to catch gaps before claims are submitted.
PT denials — medical necessity disputes, G-code errors, KX modifier issues, and plan of care lapses — require appeals that cite specific regulatory guidelines. RCMAXIS writes and submits targeted appeals backed by CMS documentation requirements to recover denied PT claims systematically.
Our certified PT billing specialists apply CMS's 8-minute rule and timed/untimed code distinctions to every claim — ensuring maximum units are billed correctly.
Physical therapy practices routinely underbill because timed code calculations are done manually and inaccurately. RCMAXIS applies a systematic approach that maximizes billable units within compliance boundaries.
Our billing specialists focus exclusively on PT, OT, and speech therapy billing. We know the 8-minute rule inside and out, understand how to correctly mix timed and untimed codes, and track Medicare therapy thresholds for every patient — preventing both underbilling and compliance risk.
Missing a G-code reporting deadline means rejected claims that must be appealed retroactively — a time-consuming process with uncertain outcomes. RCMAXIS's G-code tracking system alerts your team 2 visits before each reporting milestone, eliminating missed submissions entirely.
Detailed monthly reporting breaks down revenue by procedure, payer, and therapist — showing units billed per visit, denial rate by reason code, and collections trend over time. Practice owners get clear insight into which therapists' documentation drives denials and where improvement is needed.
All patient data is handled under full HIPAA compliance — encrypted file transfers, signed BAAs, role-based access, and regular security audits. Your therapy patients' protected health information is always secured to the highest standard.