Physical Medicine and Rehabilitation Billing Services

Physical Medicine and Rehabilitation

Physical medicine and rehabilitation practices deal with one of the most documentation-heavy billing environments in outpatient medicine. Between functional assessments, therapy evaluations, electrodiagnostic testing, and ongoing treatment plans, PM&R billing requires a thorough understanding of how payers expect claims to be structured and supported. At EZE Medical Billing, we work specifically with physiatrists and rehabilitation medicine providers across Albuquerque and New Mexico. Our goal is straightforward: keep your claims clean, your reimbursements timely, and your administrative burden as low as possible.

What Makes PM&R Billing Different

Rehabilitation medicine sits at an intersection of diagnostic services, procedural care, and long-term management. A single patient visit can involve evaluation and management coding, electrodiagnostic procedures, injections, and functional capacity documentation all at once. Getting that combination right on a claim requires attention to bundling rules, modifier usage, and payer-specific documentation standards.
Many general billing companies undercode PM&R visits because they default to lower-level E&M codes out of caution. This results in real revenue being left on the table with every claim submitted. Our coders are trained to accurately reflect the complexity of each visit without overcoding or creating audit exposure.

PM&R practices lose an estimated 15 to 20 percent of collectible revenue through undercoding and bundling errors. Specialist billing support directly addresses this gap.

Start With a Free Billing Review

If your PM&R practice is experiencing high denial rates, slow reimbursements, or coding uncertainty, a billing review will identify exactly where revenue is being lost. There is no commitment required and no charge for the initial review.

PM&R Billing Services We Provide

Our team handles the full billing cycle for physical medicine and rehabilitation practices. Here is what that looks like in practice:

Evaluation and Management Coding

Accurate E&M coding for new and established patient visits, including documentation review to support the level of service billed. We apply the 2021 AMA E&M guidelines consistently so your visit complexity is reflected in every claim.

Electrodiagnostic Billing

EMG and nerve conduction studies require precise procedure code selection and strong medical necessity documentation. We handle NCS and needle EMG billing with attention to the limb-specific coding rules that commonly cause denials.

Interventional Procedure Billing

Joint injections, trigger point injections, nerve blocks, and spinal procedures each carry their own coding logic. We apply the correct CPT codes and modifiers based on site, substance, imaging guidance, and laterality to maximize your reimbursement accuracy.

Functional Capacity and Disability Evaluations

Billing for FCEs and independent medical examinations requires careful attention to payer rules. Some payers require specific procedure codes, while others use unlisted codes with detailed reports. We know the difference.

Physical and Occupational Therapy Billing

For practices that supervise or provide PT and OT services, we manage therapy claim submission including timed versus untimed service coding, KX modifier application, and therapy cap tracking for Medicare patients.

Denial Management

Denied PM&R claims are reviewed within 24 to 48 hours of receipt. Our team identifies the denial reason, corrects the underlying issue, and resubmits or files a formal appeal as appropriate. You receive full denial status visibility in your weekly report.

Common PM&R CPT Codes We Handle

The table below reflects a cross-section of procedure codes frequently billed in physical medicine and rehabilitation. Our coders are trained across the full PM&R code set including the ICD-10 diagnosis codes that support each service.

CDT Range	Procedure	Category	Key Billing Notes
99213	Office visit, established patient	E&M	Level supported by MDM or total time documentation
99244	Office consultation, moderate complexity	E&M	Consult codes valid for most commercial payers
95910	NCS, 5 to 6 studies	Electrodiagnostic	Units must match individual studies performed
95861	Needle EMG, 2 extremities	Electrodiagnostic	Separate code from NCS; do not bundle
20610	Aspiration or injection, major joint	Injection	Modifier required for bilateral same-day procedures
64483	Transforaminal epidural, lumbar	Spinal Procedure	Fluoroscopy or CT guidance billed separately
97110	Therapeutic exercise	Therapy	Timed code; document total treatment minutes
97012	Traction therapy	Therapy	Untimed code; one unit per session regardless of duration
97750	Physical performance test	Functional	Written report required for billing
99456	Work-related disability exam, non-treating	IME/FCE	Payer-specific rules apply; verify prior to billing

Why PM&R Practices in New Mexico Work With Us

Weekly Transparency Reports

Every client receives a detailed weekly report covering claims submitted, payments received, outstanding balances, and denial activity. You always know exactly where your revenue stands.

HIPAA Compliant at Every Step

Patient data security is built into every stage of our process. We follow the full HIPAA compliance checklist across all systems, staff access, and data handling procedures.

Payer Experience Across New Mexico

We work daily with Medicare, New Mexico Medicaid through Centennial Care MCOs, Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, Molina Healthcare, UnitedHealthcare, Aetna, Cigna, and all major commercial carriers in the state.

No Long-Term Contracts

We earn your business each month through results. There are no multi-year lock-in agreements or hidden fees. Our pricing is transparent from the start.

Reduced Days in A/R

Our clean claim submission rate of 98 percent and fast follow-up on unpaid claims consistently reduce the average days in accounts receivable for our PM&R clients.

Frequently Asked Questions

Do you handle billing for both physiatrists and mid-level providers in a PM&R practice?

Yes. We bill for physicians, nurse practitioners, and physician assistants within PM&R practices. We apply the correct billing provider designations and supervision modifiers based on payer rules and the scope of each provider.

How do you handle Medicare therapy cap issues for PM&R patients?

We track therapy cap usage for Medicare patients and apply the KX modifier when services are medically necessary and exceed the annual threshold. We also flag patients approaching the cap so your team can address medical necessity documentation before a claim is submitted.

What documentation do you need from our practice to get started?

We work with whatever EHR or practice management system you currently use. During onboarding we review your current billing workflow, identify any coding gaps, and set up secure data transfer processes. Most PM&R practices are fully onboarded within five to seven business days.

How do you handle prior authorization for PM&R procedures?

We verify insurance eligibility and prior authorization requirements before services are rendered. For procedures that commonly require prior auth such as spinal injections or electrodiagnostic testing we track authorization status and alert your team when a referral or authorization is needed.

What is your denial rate for PM&R claims?

Our first-pass claim acceptance rate across specialties is 95 percent. For claims that are denied, our recovery rate is 90 percent through resubmission and appeals. These figures improve further for practices that have been with us for more than 90 days as we learn payer-specific patterns for each practice.