Physical Therapy Billing Services: Costs, Fit, and What to Ask
By MedicalBillingSelect · Company pages and Medicare rules checked October 5, 2026
A physical therapy billing service takes over your claims, payment posting, and denial follow-up. Many also send patient statements. Most of the companies below price billing as a percentage of the money your clinic collects.
Of the six companies below, three publish a numerical rate. Prompt says rates start at 3.5%. SPRY lists 4 to 6%. AdvancedMD lists a typical 4 to 8%. The other three did not list a numerical billing rate on the pages we checked.
The rate is not the whole price. A monthly minimum, required software, and what counts as "collections" can make a 4% quote cost more than a 5% one. We show the math below.
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Compare physical therapy billing services
Start with your software. Some services only work inside their own system. Others support existing systems; confirm yours.
This table shows what each company publishes. It is listed A to Z. It is not a ranking. "Not published" means we did not find it on the pages we read, so ask for it in writing. It does not mean zero.
| Company | Software setup | Published fee | Ask before you go further |
|---|---|---|---|
| AdvancedMD (managed billing) | Its core software is included. Ask if you can keep another EMR. | Typical range of 4 to 8% of monthly practice collections. Minimum: not published. Source | It serves many specialties. Ask for PT clinic references. It advertises no long-term agreement, so ask about notice and exit fees. Source |
| Medwave (billing and credentialing) | Says you can use your own software or its cloud PM/EHR option. Ask about your exact system. | Custom quote, as a percentage of all money collected. Minimum: not published. Source | "All money collected" may include copays your front desk takes. Ask which receipts count and whether credentialing costs extra. Its PT page covers both services. |
| Prompt RCM | For clinics using Prompt's EMR. | Rates start at 3.5%, per Prompt. The EMR subscription is priced separately. Minimum, setup, and initial RCM term: not published. Source | 3.5% is a starting rate, not your quote. Confirm which receipts it applies to, add the EMR cost, and ask who requests authorizations. |
| SPRY (Billing Service) | SPRY says you can use your existing EHR or SPRY's EHR. Confirm your exact system. | 4 to 6% of collections, based on total billable appointments, per SPRY. Minimum: not published. Source | Its pricing page lists credentialing and prior authorization services. Confirm the rate, which receipts count, and who handles each task. |
| StrataPT (billing with its EMR) | Billing and EMR come as one StrataPT system. Confirm the migration needed from your current software. | Percentage of collections; numerical rate and minimum: not published. No per-user or per-location software fees, per StrataPT. Source | Its FAQ says data migration is included at no charge. Confirm the scope and any other charges. Authorization-management tools do not establish that staff obtain authorizations. |
| WebPT RCM | Runs with WebPT's own billing software. | Rate, minimum, and setup: not published. Request the applicable initial RCM term in your agreement. Source | Confirm required software and the full price. WebPT says your clinic retains credentialing, registration, documentation, and treatment. Ask who handles authorizations. |
We have not used these services. This table shows what each company says about itself. It does not show how well any of them collect.
How we chose these six. We looked for companies that sell billing as a service to outpatient PT clinics and publish enough to describe. We included both kinds: services tied to a PT EMR and services that work in your current system. Other billers are not listed. Leaving one out is not a mark against it.
Where to start
- You use Prompt or WebPT. Get that company's quote first. Then get one outside quote to compare.
- You want to keep your current EMR. Start with SPRY or Medwave. Ask each to show they have worked in your exact system.
- You are opening a clinic or ready to switch software. Compare StrataPT, Prompt, and SPRY as full packages: software, billing, and moving your data.
- You need someone to handle authorizations or credentialing. Cross off any quote that leaves that work with you.
Visit a company's own page to ask for a quote:
Before you call, grab the questions to send every company. Same questions, same numbers, so the quotes can be compared.
Do you need a billing service, software, or a smaller fix?
Software gives your staff tools. A billing service gives you people who do the work. You can also buy help for just one part.
| Your situation | A sensible route | Pin this down first |
|---|---|---|
| You have a good biller with time and a backup | Keep billing in-house. Look at better software. | What the software costs. Who covers when your biller is out. |
| Your biller left, or nobody follows up on unpaid claims | A full billing service | Start date. Which work moves over. Who owns claims in the gap. |
| Daily claims are fine, but old unpaid claims are piling up | A clean-up project for old claims only | Which dates are covered. The fee on money recovered. |
| Mostly cash-pay, few insurance claims | A small scope, or none | The monthly minimum. Whether cash payments count toward the fee. |
| You want new software and billing help together | A bundled EMR and billing package | Data migration. Monthly software fees. How you get your data if you leave. |
If you are cash-based and hand patients a superbill, first check whether your current software can take payments and produce the documents you need. A full insurance-billing contract may add cost without solving your problem.
Keeping billing in-house? See what to check when your team does the billing.
What will a physical therapy billing service cost your clinic?
There is no single price. The published figures above include Prompt's 3.5% starting rate, SPRY's 4 to 6%, and AdvancedMD's typical 4 to 8%. These are different offers, not a market-wide price range or the complete cost of a contract.
Four things decide what you really pay:
- The rate. The percentage or the flat fee.
- What the rate applies to. Insurance payments only? Or every dollar, including copays and cash visits?
- The monthly minimum. If the contract charges the percentage or the minimum, whichever is higher, you pay the minimum when the percentage comes out lower.
- The extras. Software, clearinghouse, statements, setup, and data migration.
A worked example: why 4% can cost more than 5%
One clinic. It takes in $50,000 a month: $40,000 from insurers, $8,000 from patients, and $2,000 from cash visits. It gets two quotes. These are made-up quotes, not prices from any company.
| Quote A | Quote B | |
|---|---|---|
| Rate | 5% | 4% |
| What the rate applies to | $40,000 (insurance payments only) | $50,000 (all receipts) |
| Percentage charge | $2,000 | $2,000 |
| Monthly minimum | $1,000 | $2,500 |
| Base fee (the higher of the two) | $2,000 | $2,500 |
| Required monthly extras | $300 | $150 |
| Monthly cost | $2,300 | $2,650 |
| One-time setup fees | $1,200 | $600 |
| First-year cost | $28,800 | $32,400 |
| Monthly cost as a share of the $50,000 | 4.6% | 5.3% |
The 4% quote costs $350 more each month. Its minimum is higher than its percentage charge, so the minimum is what you pay. Over the first year it costs $3,600 more.
Now add your own staff time. Say Quote A leaves your team 8 hours of billing work a month and Quote B leaves 12. If an hour costs you $35, that is $280 a month for A and $420 for B. Year one becomes $32,160 for A and $37,440 for B. The $35 is only an example. Use your own number.
This is cost math. It does not tell you which biller will collect more.
Small clinics, watch the minimum. With a 6% rate and a $1,500 minimum applied this way, $20,000 in eligible monthly receipts produces a $1,500 base fee. That is 7.5% before extras. The percentage reaches the minimum at $25,000 in eligible receipts; above that, the percentage sets the base fee.
Compare your own two quotes
The calculator opens with the example above. Press "Use my quotes" to clear it and enter yours. If you have not confirmed a fee yet, leave it as "Not confirmed yet." The tool will not treat a missing fee as zero.
Use the same service scope and include required software on both sides, even software you already pay for and would keep. Do not count an included charge twice. Keep separately priced recovery of old claims outside these ongoing-billing totals. One-time fees mean additional charges, not deposits or prepayments credited against later invoices.
The first-year illustration repeats one month's receipts and fees for 12 months. If your collections or fees vary, calculate each month separately; the minimum may apply in some months and not others.
Compare two PT billing quotes
Use the same month for both quotes. Enter money you actually received, not what you billed. Leave anything you have not confirmed as "Not confirmed yet."
Illustrative example. Not provider prices.
Use ordinary decimal numbers, such as 50000 or $50,000.00; enter 5 or 5% for a 5% rate. Exclude separately billed recovery of older unpaid claims. This tool supports fixed monthly fees and percentages with no minimum or a minimum on the base fee, whichever is higher. Other fee structures need a written sample invoice.
The calculator runs in your browser and does not send or save your entries. No email required.
The formulas, if you want to check by hand
Round the monthly percentage charge to the nearest cent before applying the minimum and adding extras; half a cent rounds up. Round monthly staff cost the same way before multiplying by 12. Your contract may use a different rounding rule.
- Percentage charge = receipts the fee applies to × (rate ÷ 100)
- For percentage quotes with a confirmed greater-of minimum, base fee = the higher of the percentage charge or the minimum. With no minimum, use the percentage charge. For a fixed quote, base fee = the fixed monthly fee.
- Monthly cost = base fee + required monthly extras
- First-year cost = 12 × monthly cost + one-time fees
- Share of receipts (%) = monthly cost ÷ total monthly receipts × 100
- Monthly staff cost = monthly staff hours × hourly staff cost, rounded to cents
- First-year cost including retained staff time = first-year cost + 12 × monthly staff cost
Who will handle each part of your PT billing?
"Full service" means different things at different companies. Ask each one to name who does each task below.
| Task | What to ask |
|---|---|
| 1. Benefits and visit limits | Who checks coverage and visit limits before the first visit? When is it checked again? |
| 2. Authorizations | Who sends the request, tracks approved visits, and asks for more? A software alert is not a person doing the work. |
| 3. Credentialing | Who enrolls a new therapist or a new location with each payer? |
| 4. Charge review | Who checks the codes and units before a claim goes out? Who asks the therapist when a note is missing something? |
| 5. Claims and rejections | Who confirms each claim was accepted, and fixes the ones that bounce? |
| 6. Denials and appeals | Who finds out why, files the appeal, and tells you what happens next? |
| 7. Payment posting | Who posts insurance and patient payments and matches them to deposits? |
| 8. Patient statements and calls | Who sends statements and answers billing questions from patients? |
| 9. Old unpaid claims | Do they work claims from before your start date? At what fee? |
| 10. Reports and access | What reports do you get, how often, and who is your named contact? |
For each task, the answer should be one of five: they do it, you do it, shared, extra cost, or not confirmed. If a task you need is still "not confirmed," the quote is not ready to sign.
Your clinic remains responsible for the clinical documentation: complete treatment notes and minutes, who treated each service, plans of care, and the required certification or referral records. Put responsibility for tracking and collecting those records in writing. CMS documentation requirements
The PT Biller Test: 10 questions to ask before you sign
These ten questions help you check how a billing company handles physical therapy claims.
Ask them on the first call. You are not testing whether they memorized Medicare. Ask the person who would work your account to explain the answers and show how they check current payer rules. Looking up a rule is sensible; being unable to explain the workflow is the concern.
| # | Ask this | A good answer sounds like | Be careful if you hear |
|---|---|---|---|
| 1 | "A Medicare patient gets 24 minutes of 97112 and 23 minutes of 97110. How many units do you bill?" | "Three. Two of 97112 and one of 97110." (Worked out below.) | "Four," or "whatever the therapist typed in." |
| 2 | "What is the KX threshold this year, and what happens at $3,000?" | "In 2026, $2,480 for PT and speech therapy combined. Services above it need KX on the applicable lines and documentation supporting medical necessity. Missing KX causes those services to be denied. $3,000 is a targeted-review threshold, not a cap or automatic review." CMS | "Medicare caps therapy," or they confuse the KX and review thresholds. |
| 3 | "How do you bill a Medicare visit where a PTA did the treatment?" | "We apply CQ with GP under CMS's service- and unit-level rules. Independent PTA time generally triggers CQ above the 10% standard, but timed-unit exceptions matter. Affected services receive 85% of the otherwise applicable Medicare Part B payment. We need the PT and PTA minutes by service." CMS examples | "Same as any other visit," or they apply the percentage to the whole visit without checking the units. |
| 4 | "Medicare paid less for the second and third units on the same day. Is that a denial?" | "Not necessarily. We check the remittance and expected payment. MPPR cuts the practice-expense portion of eligible additional therapy units or procedures by 50%; the highest practice-expense unit keeps its full practice-expense payment. We challenge errors, not a correctly applied reduction." CMS manual, section 10.7 | "We appeal every reduction," or they cannot distinguish a correct adjustment from an underpayment. |
| 5 | "When do you add modifier 59?" | "Only when documentation supports a distinct service and the current NCCI edit permits a modifier. We use a more specific appropriate modifier instead when available. A different diagnosis alone is not enough." CMS modifier booklet | "Whenever a claim gets denied." |
| 6 | "Who tracks visits used against visits approved?" | A named person, a warning before the last approved visit, and a log of request dates. | "Your front desk does that," when you were told it was included. |
| 7 | "Who tracks Medicare plan-of-care certification, the qualifying referral exception, and recertification?" | A named person and a report. They know when a signed, dated order or referral plus proof of plan delivery within 30 calendar days of the initial evaluation can satisfy initial certification. Continued treatment still needs signed recertification within 90 days, or sooner for a shorter plan or significant change. CMS documentation requirements | "That is on the clinic," with no report offered, or "a referral always replaces certification." |
| 8 | "Whose bank account do payments go into? Will the business associate agreement be signed before you access protected patient information?" | "We explain the payment account and any lockbox or agent arrangement in writing. Your clinic keeps control. The BAA is in place before we access protected patient information." HHS | Payments go to the billing company without a clear written arrangement. No BAA offered. |
| 9 | "Can you send a sample monthly report with made-up data?" | A real sample: collections by payer, unpaid claims by age, denials by reason. They explain how each number is counted. | One "collection rate" with no definition. |
| 10 | "If we leave, who finishes open claims, what does it cost, and how do we get our data?" | A written plan with a set number of days, a data format you can use, and a price. | "We can talk about that if it comes up." |
Use the answers to guide follow-up. Ask for written evidence when an answer is unclear, and resolve important gaps before signing. This checklist helps you choose what to investigate; a total score would not prove experience or service quality.
The initial-certification exception in question 7 applies to qualifying therapist-established plans, with the signed referral and evidence of delivery to the referring practitioner kept in the record. It does not replace recertification or apply to comprehensive outpatient rehabilitation facilities (CORFs). CMS
Question 1, worked out
For Medicare therapy codes defined in 15-minute units, add the qualifying timed treatment minutes for the same discipline on the same date of service. Then find the band. This is commonly called the 8-minute rule. Keep untimed services, such as evaluations, out of that timed-minute total.
- 8 to 22 minutes = 1 unit
- 23 to 37 minutes = 2 units
- 38 to 52 minutes = 3 units
- 53 to 67 minutes = 4 units
In the example, 24 minutes of 97112 (neuromuscular re-education) plus 23 minutes of 97110 (therapeutic exercise) is 47 minutes. That is 3 units: two of 97112 and one of 97110. This is CMS's own example in the Medicare Claims Processing Manual, Chapter 5, section 20.2.
A biller who rounds each code on its own gets 4 units. Under Medicare's method, that is one unit too many.
The coding examples describe selected Medicare rules. Use them to ask a billing company how it works, not as instructions for an individual claim. Other payers can use different rules; ask how the biller checks yours.
2026 numbers a PT biller should already know
| What | 2026 figure | Source |
|---|---|---|
| KX modifier threshold | $2,480 for PT and speech therapy combined. A separate $2,480 for OT. | CMS |
| Medical review threshold | $3,000 for PT and speech therapy combined; a separate $3,000 for OT. Not every claim above it is reviewed. Indexing begins in 2028. | CMS |
| Medicare conversion factor | $33.40 for clinicians who are not qualifying alternative payment model participants (non-QPs); $33.57 for qualifying participants (QPs). The 2025 factor was $32.35. These are rounded conversion factors, not payments per visit. | CMS fact sheet |
| Telehealth by PTs | PTs remain eligible to furnish covered Medicare telehealth services through December 31, 2027. The service and claim must meet the applicable coverage and billing requirements. | CMS |
| Authorization deadlines | The 2026 rules generally give affected Medicare Advantage, Medicaid, and CHIP payers 7 calendar days for standard non-drug requests and 72 hours for urgent requests, or less if the patient's condition requires it. Program-specific extensions and implementation dates apply. These deadlines do not extend to commercial employer plans or qualified health plans on federally facilitated Exchanges. | CMS current FAQ |
For Medicaid managed care, the 7-day standard applies to rating periods starting on or after January 1, 2026. Have the biller check the patient's specific plan and any shorter applicable deadline. 42 CFR 438.210(d)
Check the contract before you sign
Get these nine things in writing.
| Term | What to get in writing |
|---|---|
| Fee | The exact percentage or flat fee |
| What it applies to | Insurance payments, patient payments, copays taken at your desk, cash visits |
| Monthly minimum | The amount, and whether it is waived while you ramp up |
| Software | What you must use, what it costs, and who owns the license |
| Work included | The ten tasks above, each marked theirs, yours, shared, extra cost, or not confirmed; split shared work and price required extras |
| Old unpaid claims | Whether they work them, and at what rate |
| Term and renewal | How long, and whether it renews on its own |
| Notice to cancel | How many days, and how notice must be sent |
| Leaving | Who finishes open claims, any exit fee, and how you get your data |
You still own the claims. For Medicare, your clinic remains responsible for claims submitted by its billing agent, even when someone else presses submit. That is why oversight matters. CMS manual, Chapter 24, section 30.2
Check your state's and payer's rules on percentage fees. New York restricts professional fee sharing by physical therapists, with specific exceptions. Its rules can affect percentage-based billing arrangements. New York rules For Medicaid payments made to a billing agent that furnishes statements and receives payment in the provider's name, federal rules require compensation tied to processing costs, unrelated to amounts billed or collected, and not dependent on collection. Federal rule New York's Medicaid manual sets similar conditions. State manual, pages 33–34 Have your attorney check the proposed arrangement against your state and payer rules before you sign; ask for a flat-fee option if needed.
Plan the handoff.
| Stage | What you should have |
|---|---|
| Before signing | Signed fee and task list. Contract and business associate agreement reviewed. |
| Before the switch | A list of open claims, pending authorizations, and appeals, with an owner for each. For Medicare, notify your contractor in writing of a billing-agent or clearinghouse change and its effective date before the switch. CMS |
| First week | Proof that claims are being accepted and payments are reaching your account. |
| Each month | A review of unpaid claims, open tasks, and old claims. |
| If you leave | Your data, an end date for access, agreed handling of any retained patient information, and a final bill you can check. HHS contract guidance |
Send the same questions to each company
Quotes are hard to compare when each company answers different questions. Send every company the same note with the same numbers.
Share totals only. Do not send patient records or logins at this stage.
Subject: Written proposal for outpatient physical therapy billing We are looking at billing help for an outpatient physical therapy clinic. State(s): [state or states] Clinicians and locations: [how many PTs and PTAs; any OT or speech therapy; how many sites] Current EMR and billing system: [system names] Software: [we want to keep our system / we are open to changing] Main payers: [payer names and plan types] Typical monthly receipts: [insurance $ / patient payments $ / cash-pay $] Main problem to fix: [one or two sentences] Timing: [when we want to start] Older unpaid claims: [total $ and how old, if you want help with them] Please answer in writing: 1. What exact service and software are you proposing? Do we have to change systems? 2. What is your rate or fixed fee? Which receipts does it apply to (insurance, patient payments, copays we collect, cash-pay)? How do you treat refunds and take-backs? Please show a sample invoice at our volume. 3. Is there a monthly minimum? How is it applied? What do software, clearinghouse, statements, setup, and data migration cost? What do you charge to work older unpaid claims? 4. Who does each of these: benefits checks, authorizations and renewals, credentialing, coding and documentation questions, claims and rejections, denials and appeals, payment posting, patient statements and calls, reports? 5. What stays with our staff? What is optional or priced separately? 6. Please send a sample monthly report with made-up data, and explain how your team handles timed units, the KX modifier, and PTA visits. 7. What are the first term, renewal, notice period, exit costs, data export terms, and your duties for claims still open when we leave? 8. Who is our named contact? What is the start-up plan? Please send your business associate agreement. If something stops you from giving a full quote, tell us what it is. Please do not ask for patient records at this stage.
When the answers come back, put two of them in the calculator.
If your biller just left
Protect this month's cash before you pick a long-term company.
- Restore the clinic's access. Confirm clinic-controlled access to the EMR, clearinghouse, payer portals, and bank lockbox. Give each authorized person their own account and remove access the departed biller no longer needs. Do not reuse their personal login. HHS access guidance
- Pull three lists today. Visits not yet billed. Claims sent but not paid. Denials nobody has worked.
- Work the nearest deadlines first. Check filing and appeal deadlines across all three lists. Missing one can cost payment; check the payer's exceptions before writing a claim off. Medicare filing rule and exceptions
- Ask each company about claims in progress. Will they take them over, and at what fee?
- Lean toward a service that works in your current software. Changing systems and billers in the same month is a lot.
Questions clinic owners ask
Does a PT billing company need to be local?
No. Most work is done online. What matters is that they know your state's payers, work in your software, and answer during your hours. Ask who your contact is and how fast they reply.
What if we also do occupational or speech therapy?
Ask about each one. Prompt and StrataPT both say they serve PT, OT, and speech clinics. In 2026, Medicare tracks OT under its own $2,480 KX threshold, separate from PT and speech combined, so your biller needs to track the applicable totals for each patient. CMS
Will outsourcing guarantee better collections?
No. A company's claim on its website is not a result for your clinic. Compare written scope, ask how each number in their reports is counted, and watch the first three months closely.
How long does switching take?
Timing depends on the company and your setup. WebPT describes a nine-week onboarding process. StrataPT says past transitions have ranged from 24 hours to a couple of weeks. SPRY advertises data migration in as few as 30 days. These describe different parts of a switch, not a promised date for your first claims. Ask each company for your written start-up plan and who works claims during the handoff.
I am a patient with a question about my physical therapy bill. Where do I start?
Call the billing office on your bill. For coverage questions, call your health plan. This page helps clinics choose billing help. We cannot look up or fix a patient account, so please do not send us your information.
How we checked this page
On October 5, 2026, we read each company's own pricing and service pages, the Medicare and other payer-rule sources, and the government legal and privacy guidance linked above. Company details show what each company publishes. They do not show how well it performs. We did not use or test any billing service, and we did not score customer reviews. The quotes in the cost example are made up to show the math.
Prices and terms change. If something here is out of date, tell us and we will check it. You can also read how we compare billing companies.