This article highlights the role of telehealth in modern therapy practices and its benefits, including improved patient satisfaction, flexibility, and accessibility. It provides a guide to delivering effective virtual therapy sessions and explains the importance of EMR software with built-in, HIPAA-compliant telehealth features. Tools like HelloNote help streamline operations, enhance patient care, and ensure compliance, keeping therapy clinics competitive in the evolving healthcare environment.

In this day and age, the virtual world and online businesses are absolutely booming. Since the pandemic began in early 2020, if people have the option to stay home vs going out, many are choosing to stay home. For therapy practices, this has required a pivot in the way sessions are conducted and held. Telehealth is here to stay and this article will walk you through why you are missing out a huge opportunity within your practice if you have not yet pivoted to add a telehealth treatment service to your therapy business.

When patients started having increased fears of being in-person at clinics, due to increased risk of exposure to COVID and social distancing requirements, many practices saw a drop in their caseload. To combat this decline, several therapy clinics began heavily relying on telehealth for continued patient care and services. Since telehealth was not widely utilized prior to this, unless in very specific instances, many practices scrambled to find a way to provide these services while still abiding by HIPAA. While our country begins to adapt to its new normal, it appears telehealth is a treatment option which will be sticking around for the foreseeable future, especially when it comes to physical therapy.

Several patients might not understand what telehealth therapy is or how it works so patient education will play a crucial role in portraying how effective telehealth therapy can be to ease any concerns the patient may have. Many patients will likely wonder how telehealth therapy appointments, through a computer, are going to help their condition improve, especially since physical therapy has been thought of as a very “hands-on” profession for several years.

One of the best ways to ease the patients’ concerns is to provide them with research as to the benefits of telehealth and how satisfied previous telehealth physical therapy patients have been. Based on a recent research article from The Musculoskeletal Journal of Hospital for Special Surgery, telehealth for outpatient physical therapy clinics has shown to be successful. After data was collected and analyzed, there did not appear to be a statistical difference between in-person and telehealth patient satisfaction, meaning patients have been just as satisfied with their results from telehealth physical therapy appointments, as they have been with in-person care. By providing thorough patient education, re-assurance, and research articles, patients are likely to have decreased apprehension or fears about the effectiveness of telehealth therapy.

Why patients choose tele physical therapy over in patient care:                                                                                                                               There are many reasons why patients may choose telehealth over in-patient care.

1. One reason is less stress on the patient’s end, as the patient does not have to worry about leaving work at a set time or running late due to being stuck in traffic. 
2. Another reason is increased flexibility of scheduling appointments as patients can attend their physical therapy session from wherever they are, even if they are just on their lunch break at work. 
3. A third reason why telehealth is often favored over in-person appointments is the benefit of saving money on transportation costs as patients do not have to worry about paying for gas, parking, etc.
4. Finally, telehealth appointments decrease the chance of contracting an illness as patients are no longer having to sit in a crowded waiting room for any period of time.

As the popularity of telehealth continues to increase and trend upwards, both at in-person clinics and online therapy businesses, it is important to have a PT EMR system which allows for increased ease and access to telehealth appointments.

Quick checklist of how to provide tele therapy services:

To successfully provide telehealth services to patients, you want to make sure your therapy note software has the capabilities and functionalities to host a telehealth appointment.

1. HIPAA Compliance Software such as HelloNote: Apart from having telehealth capabilities already integrated into the software, the single most important feature is that telehealth appointments can be completed securely. If you are not hosting your telehealth sessions through a secure EMR system, then you are not in compliance with HIPAA which can result in several legal issues, especially if the patient’s information is leaked or the session is hacked. Before offering telehealth appointments to your patients, be sure you have the correct capabilities and access to host this treatment option within your EMR. One PT documentation software that has an integrated and secure telehealth feature built into its platform, to maintain HIPAA compliance and prevent any worries or concerns on your end, is HelloNote.
2. You need to have professional lighting and video capture via a webcam.
3. Make sure you can find a quiet and clean room to perform your tele-therapy session in.

And it’s really as easy as that!

Telehealth therapy appointments are likely to continue increasing in popularity, based off of trends in 2020. If you are just starting or have recently begun a private practice outpatient therapy clinic, then make sure you purchase a PT documentation software with telehealth capabilities built in, otherwise you will miss out on several potential patients.

This article provides a detailed overview of commonly used modifiers in physical, occupational, and speech therapy billing. It explores essential modifiers such as the 59, GP/GO/GN, KX, and GA, with a focus on their application in Medicare and commercial insurance claims. Understand how these modifiers affect reimbursement and ensure accurate billing. Additionally, it discusses how EMR software like HelloNote can simplify billing processes and support proper documentation for compliance.

We have officially arrived into 2021…woohoo, we made it! While a new year may have arrived, some things in the therapy world continue to remain the same. Most, if not all, therapists, whether physical, occupational, or even speech, have entered this career path to improve patients’ lives and make a difference in the lives of those around them. However, it becomes increasingly difficult to continue improving patients’ lives, if you are not billing insurance correctly, resulting in decreased reimbursement and overall profit.

In our last blog post, we discussed the 8-minute billing rule for Medicare, and this time we are going to touch on therapy modifiers for physical, occupational and speech therapy services. What exactly is a modifier? I am glad you asked. A modifier is a code which is added to your billing and provides additional information to the insurance company when diagnosis and procedure codes are not enough for reimbursement. There are two different categories of therapy billing modifiers:

1. Therapy modifiers– two-digit codes applied to CPT codes and are typically included when billing both Medicare and commercial insurances
2. Level II HCPCS (Healthcare Common Procedure Coding System) Modifiers– two letter codes which are included when billing Medicare, Medicaid and only some commercial plans (such as United Healthcare)

Let’s start by discussing CPT modifiers as there is really only one commonly used modifier for therapy services, which is the 59 modifier. This modifier is used to differentiate between two common or similar services that were provided during the same session. When using the 59 modifier, you are indicating to the insurance company that each service was medically necessary and performed independently of the other. One typical example of when to use this modifier is if you bill for manual therapy (97140) and therapeutic activities (97530), in the same session. As long as you performed each service during separate 15-minute increments, then you would add the 59 modifier on CPT code- 97530 to ensure you receive reimbursement for both codes.

As for level II HCPCS
modifiers, there are three frequently used modifiers, especially for
specific insurances, such as Medicare/Medicaid and more recently, United
Healthcare. Let’s take an individual look at each modifier:

Reference chart below (some common CPT codes if 59 Modifier is allowed. For a full list, please go to National Correct Coding Initiative (NCCI) or consult the official CMS guidelines.

If column 2 shows “Not allowed”, then the CPT code cannot be billed with the code in column 1. If column 2 shows “Yes”, then the 59 modifier can be used to bypass the code edit:

1. GP/GO/GN Modifier- This modifier is often used in an interdisciplinary setting where there may be confusion about who provided the services, such as a hospital or outpatient clinic in a physician’s office. When billing for therapy services, be sure to include this modifier so that insurance companies are able to accurately reimburse, based on the type of therapy and in accordance with that member’s group benefits. For physical therapists, use -GP, occupational therapists, use -GO, and speech language pathologists, use -GN.
2. KX Modifier- Patients with Medicare insurance have a threshold for therapy services, and once the patient exceeds that threshold, Medicare does not usually reimburse for provided services. In 2021, for PT and SLP services, the combined cap is $2,110 and for OT services, the cap is $2,110. If a patient who is receiving therapy services exceeds this cap, then you would add the KX modifier. Adding this modifier indicates continued treatment is medically necessary and that necessity has been sufficiently justified in your documentation. If using the KX modifier, you do not want to use it before the patient has reached their therapy cap, as that could cause a red flag and lead to a decreased likelihood of approval or reimbursement from Medicare.
3. GA Modifier- Last, but not least, is a modifier which is often used once patients have reached a functional plateau, but still wish to receive therapy services. As you know, maintenance therapy is not considered medically necessary so this modifier allows you to bill secondary insurances or bill the patient directly, for non-Medicare covered services. If you end up in a situation where you have to use this modifier, make sure you have communicated with the patient that should they not have any secondary insurance, they will be responsible for paying out-of-pocket for therapy services. By communicating this upfront with your patients, it decreases the likelihood of any confusion or miscommunication.

**One last quick tip, for therapy businesses who have PTAs or OTAs, Medicare now requires that you use an assistant modifier, CQ for PTAs and CO for OTAs, for services performed.

Sometimes insurance is confusing, time consuming or flat out disheartening, but it is important to remember that billing correctly is essential. Modifiers are used to ensure therapists are receiving the appropriate reimbursement from insurance companies so that they can continue to put the patient and their needs first. While modifiers and insurance, in general, can be tricky, consider buying an EMR software that will assist you with your billing, such as HelloNote. As always, remember to support your billing with your documentation, if your notes are not supporting what you are billing insurance for, then you should not be billing for it!

Medicare Part A and B deductibles discussion for 2021, including coverage details, patient responsibilities, and how out-of-pocket costs affect physical therapy services.

It seems as if therapy services are an ever-evolving world. Not only is there constantly new research and studies out there proving which exercises you should and should not be having patients perform based on their injury or diagnosis, but it appears as if every time we turn around, there is some new insurance change. This year is no different in that patients who have Medicare insurance, either Part A or Part B, have a new deductible they must meet before their coinsurance will begin.

Before treating your patients, it is extremely important they understand their benefits and why physical, occupational, or speech therapy is important for them, especially as their deductible increases. When a deductible increases, it means the patient is having to pay more out-of-pocket costs until their deductible has been met. Given the current state of the economy and everything going on in the world, paying more out-of-pocket might be a hardship for some patients, so ensuring patients understand what they are responsible for is crucial.

Medicare Part A

Medicare insurance has several different parts to it. The main ones we tend to focus on for therapy services are Part A and Part B. The reason for this is because Part A covers hospital, home health services, hospice, and skilled nursing stays while Part B covers outpatient physical therapy services.

In 2021, the deductible for Part A services is $1,484, which is an increase of $76 from $1,408 in 2020. This amount covers the patients’ share of costs for the first 60 days of a Medicare-covered inpatient hospital stay during a benefit period. In addition to the $1,484 deductible, the patient will also be responsible for coinsurance charges, depending on how long and where the patient is staying.

The nice thing about Medicare Part A is that 100% of the costs are covered for up to 60 days in the hospital and 20 days in a skilled nursing facility. However, when patients require a longer stay, the costs can quickly add up. If a patient stays more than 60 days in the hospital, from day 61 to day 90, the patient will be responsible for paying $371 coinsurance each day. If a patient has to stay longer than 90 days, starting on day 91, the patient is responsible for paying $742 coinsurance per day.

If the patient is transferred to a skilled nursing facility for more long-term care, the patient can stay in the SNF for 20 days before having to pay coinsurance. Beginning on day 21 of the individual’s stay, the patient is responsible for paying $185.50 per day. While there are benefits to having Medicare Part A, hospitals and skilled nursing facilities can be quite expensive.

Medicare Part B

Focusing on Medicare Part B, which covers outpatient physical therapy services, the 2020 deductible was $198, just under the $200 mark. For 2021, the annual deductible for Medicare Part B has increased by $5 and is now $203. Once the $203 deductible is met, patients typically pay 20% of the Medicare-approved amount for most doctor services, including all therapy services.

In more layman’s terms, once a patient has had enough doctor and/or therapy visits in 2021 to where they have paid a total of $203 out-of-pocket, Medicare will cover 80% of the cost of their remaining services for the year. Once the Medicare benefits kick in, the cost of therapy services will reduce significantly, and patients will be paying far less out-of-pocket.

The Threshold for Outpatient Therapy

Another unique change with Medicare is that there is no longer a cap on outpatient therapy, speech therapy, or occupational therapy services. Instead, the cap has been renamed as a “threshold,” and if the therapist can prove that continued care is medically necessary through their documentation, and Medicare approves, then you, as a therapist, can go over the threshold for that patient.

The 2021 thresholds for outpatient physical therapy and speech-language pathology, combined, is $2,080. The threshold for occupational therapy is also $2,080.

Importance of Patient Education

Insurance itself can be a very slippery slope, and many patients do not fully understand their benefits or what they mean, which is why your physical therapy office plays an important role in ensuring each patient understands their specific benefits. As a physical therapist, depending on someone’s insurance, it might come down to you placing a greater emphasis on patient education during the initial evaluation so that your patients will continue to show up, especially if the patient has not met their Medicare Part B deductible for the year.

While insurance tends to not be a highlight of being a physical therapist, it does play a vital role in making sure our patients are receiving the correct amount and level of care they deserve

Here is an update about Medicare Part A and Part B.

This article presents thoughtful Christmas gift ideas tailored for physical therapy clinics. It highlights practical options such as webcams, microphones, EMR software subscriptions, and educational posters/models to help enhance clinic operations and patient care. These suggestions are perfect for anyone seeking meaningful and useful gifts this holiday season.

As Christmas and the end of the year approach, you might know someone who recently opened a physical therapy (PT) business, or you could be a patient searching for the perfect gift for the clinic you attend. Selecting a thoughtful gift for a PT clinic can be challenging, but at HelloNote, we’ve made it easier by compiling four practical and meaningful gift ideas. These items not only show appreciation but also enhance clinic operations and patient care for years to come.

1. A High-Quality Webcam for Telehealth

One of the most practical Christmas gift ideas for a physical therapy clinic is a reliable webcam. Telehealth services have grown exponentially, especially after the events of 2020, and having the right equipment is essential. A high-quality webcam allows therapists to offer clear demonstrations of exercises and provide effective cueing and feedback during virtual sessions.

By gifting a top-tier webcam, you’re not only enhancing the clinic’s telehealth capabilities but also ensuring that patients receive the best care during their online appointments. Look for webcams with HD resolution and good low-light performance for optimal results.

2. A Professional Microphone for Clear Communication

Clear communication is crucial during telehealth appointments and online webinars. That’s why a professional microphone is another excellent Christmas gift idea for physical therapy clinics. Therapists often spend considerable time explaining exercises and providing detailed education to patients during virtual sessions.

A good microphone ensures that every word is heard clearly, enhancing the overall patient experience. It’s also a valuable tool for clinics hosting webinars or live classes on topics like ergonomics or fitness tips for remote workers.

3. EMR Software Subscription

Every physical therapy clinic needs efficient electronic medical record (EMR) software to streamline documentation, scheduling, billing, and telehealth services. If you’re looking for a game-changing Christmas gift, consider contributing to an EMR subscription.

HelloNote, for instance, is an excellent EMR option that offers features like HIPAA-compliant telehealth, patient scheduling, billing solutions, and documentation tools. Gifting an EMR subscription not only supports clinic operations but also simplifies day-to-day management for the business owner.

4. Informational Posters and Models

For visual learners, understanding complex medical diagnoses and treatments is much easier with visual aids. Posters of the human anatomy, joint models, and other educational tools are thoughtful Christmas gift ideas that can be used during patient consultations and treatments.

Consider gifting a detailed spine model, muscle group charts, or nerve structure illustrations. These items are not only practical but also add a professional touch to the clinic’s environment.

Why Practical Gifts Matter for PT Clinics

Choosing thoughtful and useful Christmas gift ideas shows that you understand the unique needs of physical therapy clinics. Functional gifts like webcams, microphones, EMR subscriptions, and educational tools improve patient care and help clinic owners manage their practices efficiently.

Extra Tip: Consider Tax Deductions!

Did you know that business-related expenses, including some Christmas gifts, may qualify as tax deductions? For clinic owners, investing in practical tools like those mentioned above can be a win-win: improving business operations while reducing taxable income.

Final Thoughts

Finding the perfect Christmas gift can be daunting, but thoughtful, practical gifts go a long way in showing appreciation and support. By choosing items like webcams, microphones, EMR software, or educational tools, you’re giving something that will make a lasting impact.

This holiday season, give the gift of functionality and support to the physical therapy clinics and business owners in your life. Not only will these Christmas gift ideas bring joy, but they will also contribute to the clinic’s success in the year ahead.

Guide to tax deductions for physical therapy business owners. Maximize savings with tips on marketing, rent, utilities, and liability insurance.

As December and the end of the year are quickly approaching, tax season is almost upon us! What does that mean? It means it’s time to start collecting and preparing any expenses throughout the year that can be claimed as deductions for your physical therapy business.

If taxes overwhelm you or it’s your first year as a physical therapy business owner, have no fear. Below, you’ll find a detailed overview of some of the most common tax deductions available to physical therapy businesses, along with practical examples and tips to maximize your savings.

Disclaimer: Some of these deductions might not apply to your business, depending on how you file as a business entity for taxes. Always consult with a certified tax professional or accountant before implementing any of the suggestions below.

Marketing and Advertising

Marketing is one of the most beneficial tax deductions for small businesses, as it’s typically 100% tax-deductible. This expense not only helps you save money during tax season but also boosts community awareness and drives patient caseloads.

Examples of deductible marketing expenses include:

• Paying for website updates or new design features.
• Purchasing online ad space on platforms like Google Ads or Facebook.
• Printing physical brochures or newsletters for patient education.
• Running local radio or TV advertisements.

Pro Tip: Planning for next year? Purchase marketing materials in December for use in January and deduct them on this year’s taxes. For example, if you spend $1,000 on digital ads in December for a January campaign, you can deduct the full amount on your current year’s return.

Rent Payments and Utilities

If you rent or lease office space for your practice, monthly rent payments are a significant tax deduction. According to the National Federation of Independent Business (NFIB), rent accounts for 10-15% of typical small business expenses—making it a substantial write-off.

Deductible utilities include:

• Electricity bills.
• Water and heating costs.
• Business-specific phone and internet services.

Example Calculation:
If your annual rent totals $24,000 and utilities cost $3,600, you can claim up to $27,600 in deductions.

Taxes and Licenses

Any fees associated with running your business, such as city or state business licenses, are deductible. Additionally, annual renewal fees for professional licenses, like a physical therapist license, can also be written off.

Important Note: Original license fees (e.g., your first state PT license) are not deductible.

Example:
If your city business license costs $250 annually and your PT license renewal is $200, you can deduct $450 from your taxable income.

EHR Software

Every physical therapy practice needs reliable documentation and billing software. Whether you’re subscribing to a cloud-based system or using licensed software, these expenses are often tax-deductible.

Examples of deductible software-related costs:

• Monthly subscription fees for EHR systems.
• Initial setup fees for onboarding software.
• Costs for software updates or additional features.

Industry Data: The average cost for EHR software ranges from $99 to $499 per provider, per month, depending on features and scalability. Over a year, this could mean a deduction of $1,200 to $6,000 or more.

Business Car Mileage and Maintenance

If you offer home health services or make frequent trips for business purposes, mileage and car maintenance can be significant deductions.

Mileage Deduction for 2023:
The IRS standard mileage rate is 65.5 cents per mile for business use.

Example Calculation:
If you drove 5,000 miles for work in 2023:
5,000 miles × $0.655 = $3,275 deduction

Other deductible car-related expenses:

• Oil changes and maintenance.
• Insurance premiums (percentage used for business).

Office Supplies

From basic stationery to essential cleaning materials, most office-related purchases are tax-deductible.

Examples of deductible supplies include:

• Cleaning supplies (especially important for infection control).
• Printer ink, paper, and mailing supplies.
• Furniture like desks and chairs, if purchased specifically for the practice.

Pro Tip: Save receipts for every purchase, no matter how small. Over time, these minor expenses can add up to significant deductions. For instance, spending $500 annually on cleaning supplies alone is worth noting.

Liability Insurance

Professional liability insurance is a must-have for physical therapy practices. Fortunately, these premiums are deductible.

Example:
If your annual liability insurance premium costs $1,500, you can deduct the entire amount.

Why It’s Important: Liability insurance protects your business from legal risks, ensuring financial stability in case of unexpected claims.

Tax Filing Best Practices

While these deductions can save you significant money, proper organization and preparation are essential to make the most of them.

Tips for Success:

1. Use Accounting Software: Platforms like QuickBooks or Wave make it easy to track expenses and generate reports for your accountant.
2. Keep All Receipts: Store receipts digitally or in a designated folder to avoid scrambling for proof during tax season.
3. Consult a Professional: A tax accountant familiar with healthcare businesses can identify deductions you might overlook.

Did You Know?

According to the IRS, small businesses save an average of $12,500 annually by properly claiming deductions.

Final Thoughts

Owning a physical therapy practice comes with its challenges, but tax deductions can ease the financial burden. From marketing and utilities to EHR software and liability insurance, these write-offs are powerful tools for optimizing your tax return.

Remember, staying organized and seeking professional advice ensures compliance and maximizes savings. Start preparing now to make this tax season stress-free and rewarding!

Discover essential the Physical Therapy Medicare billing guidelines, including accurate use of ICD-10 and CPT codes, understanding service-based and time-based codes, and following the 8-minute rule to ensure compliance and maximize reimbursement.

As physical therapists, one of the most fulfilling aspects of our job is helping patients regain their quality of life after an injury or health issue. However, not everything we do is as enjoyable. Medicare billing, while a crucial part of our practice, can be complex and tedious. Proper billing ensures that clinics are reimbursed and therapists are paid for their services. Today, we’ll dive into what might be the most challenging part of our profession: Medicare billing. With different standards for acceptable CPT codes, unit limitations, and reimbursement structures, it’s essential to understand Medicare’s unique guidelines. Let’s get started.

ICD-10 Codes: The Starting Point

1. The billing process begins after the initial evaluation with the selection of ICD-10 codes to open a claim.

   • Typically, ICD-10 codes are provided by the referring physician.
   • In states allowing direct access to PT services, therapists may need to assign the codes based on the evaluation.
   • Always choose the most specific code(s) that accurately describe the patient’s condition or reason for therapy.

CPT Codes: The Core of Medicare Billing

CPT codes are the backbone of billing and must reflect the services rendered during each session. These codes are subject to strict Medicare scrutiny, making accuracy essential.

• Most PT-related codes fall under the 97000 section, which includes:
  • Initial evaluations (categorized as low, moderate, or high complexity)
  • Therapeutic procedures (e.g., therapeutic exercises, manual therapy)
  • Neuromuscular re-education
  • Group therapy and supervised modalities

For evaluation codes, complexity is determined by factors such as patient history and clinical presentation. Proper classification ensures compliance and appropriate reimbursement.

Service-Based vs. Time-Based CPT Codes

Understanding the difference between service-based and time-based codes is crucial:

• Service-Based Codes:
  • Examples: Initial evaluation, re-evaluation, unattended electrical stimulation, hot/cold packs.
  • Billed as one unit, regardless of time spent.
• Time-Based Codes:
  • Examples: Therapeutic exercises, manual therapy, gait training, attended modalities.
  • Require adherence to the 8-minute rule.

For example, if you spend 18 minutes on therapeutic exercise and 10 minutes on manual therapy, your total treatment time is 28 minutes. You would bill 2 units.

Key Considerations for Medicare Billing

1. Service-Based Codes Are Not Subject to the 8-Minute Rule:
   These codes can still be billed in addition to time-based codes, provided the service is medically necessary.
2. Document Total Treatment Time:
   Combine timed and untimed minutes to ensure accurate unit allocation.
3. Stay Updated on Medicare Policies:
   Guidelines frequently change, making ongoing education essential for compliance and maximizing reimbursements.

Why Accuracy Matters

Navigating Medicare billing is undoubtedly complex, but with a solid understanding of ICD-10 and CPT codes, service classifications, and the 8-minute rule, the process becomes more manageable. Proper billing ensures compliance, reduces the risk of denied claims, and helps secure fair compensation for the valuable services you provide.

By staying informed and organized, you can focus on what you do best—helping your patients regain their health and quality of life.

Here is the updated Physical Therapy Medicare Billing Guidelines 2025.