Blog | Physicaltherapynow.com

NCCI Edits version 31.2 now in effect. As of July 1, 2025, the National Correct Coding Initiative (NCCI) Edits Version 31.2 is officially in effect and will remain active through September 30, 2025. These edits are critical to ensure proper coding and billing in all outpatient therapy settings for both original Medicare and Medicaid beneficiaries. Whether you’re a provider or a billing professional, staying compliant with the latest NCCI updates is essential for avoiding denials and maintaining proper reimbursement.

National Correct Coding Initiative edits are coding rules published by CMS (Centers for Medicare & Medicaid Services) to:
-Prevent improper payment when incorrect code combinations are billed
-Promote accurate and ethical billing practices
-Ensure services are reported in a standardized, non-duplicative way

These edits include bundled code pairs, mutually exclusive edits, and the need for appropriate modifiers (like Modifier 59 or X-modifiers) when billing certain code combinations together. While CMS has not yet released the detailed summary of changes for Version 31.2 publicly, the quarterly updates typically involve:

-New bundling edits: CPT code pairs that can no longer be billed together unless modifiers are used
-Updated rationale for existing edits
-Revised guidance on modifier usage

Therapists and billing teams must closely review the current NCCI tables and cross reference them with their EMR or billing system to ensure claims submitted during Q3 July 1 to September 30, 2025 comply with the edits. At Physical Therapy Now, our billing and compliance teams stay ahead of these quarterly changes to ensure we deliver not only excellent care but accurate, timely claims submissions.

¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at https://physicaltherapynow.com/franchise/

If you’re an Aetna member looking to begin physical therapy, your road to recovery just got easier. Aetna has announced two major policy changes that remove long-standing administrative barriers to care. These changes mark a significant step toward improving patient access and autonomy in outpatient physical therapy.
What Are the Two Big Changes?
Effective June 17, 2025, Aetna will implement the following updates:
No Physician’s Order Required for Physical Therapy: Patients with Aetna coverage will no longer need a referral or order from a physician before starting outpatient physical therapy services. This streamlines access to care and supports the growing trend of direct access, where patients can begin treatment without waiting for a doctor’s approval.
The second update is No Physician Signature Required on the Plan of Care: Physical therapists are now no longer required to obtain a physician’s signature or approval for the written plan of care. This change allows therapists to begin and adjust treatment plans based on clinical judgment without added administrative hurdles. These changes mark a major step forward in removing unnecessary barriers to timely rehabilitation services.

These updates take effect on June 17, 2025. Claims submitted for services provided on or after that date will be subject to the new guidelines and Aetna has clarified that these updates apply only to outpatient physical therapy services.

Aetna’s decision to eliminate the physician order and signature requirements for physical therapy is a win for patients, therapists, and care access overall. By simplifying the process, Aetna is aligning with evidence-based practices that support direct access and empower physical therapists to deliver care quickly and effectively.

At Physical Therapy Now, we believe healing should never be delayed by distance, traffic, or a busy schedule. That’s why we’ve integrated telehealth physical therapy into our services, so you can access expert care from the comfort of your home. Whether you’re managing pain, recovering from surgery, or following a long-term treatment plan, telehealth brings physical therapy to your screen without compromising quality.
Telehealth Physical Therapy uses secure video conferencing technology to connect you with a licensed physical therapist in real time. Just like an in-person session, your therapist: evaluates your condition, guides you through customized exercises, offers education on posture, movement, pain management, tracks your progress and adjusts your treatment plan. All you need is a smartphone, tablet, or computer with internet access.
You might be surprised by how much can be done remotely. Common conditions we treat through telehealth include: back and neck pain, shoulder, hip, and knee pain, post-operative recovery, balance and fall prevention, arthritis joint stiffness and general deconditioning or mobility issues.

For cases requiring hands-on treatment, we may use a hybrid model, starting with telehealth and transitioning to in-clinic care when appropriate. Studies show that virtual physical therapy can be just as effective as in-person visits for many conditions, especially when combined with regular follow-up and a clear home exercise plan. At Physical Therapy Now, we’re proud to offer this modern solution while maintaining the same personalized, high-quality care our patients know and trust.

As more states across the U.S. adopt direct access laws, allowing patients to see a physical therapist without a doctor’s referral, many Medicare beneficiaries are asking:
“Can I start physical therapy without a referral under Medicare?”

The answer is not quite. While state laws may allow direct access, the Medicare program has its own rules when it comes to outpatient therapy services. Direct access means you can visit a licensed physical therapist without a physician’s referral or prescription. Most states support this model, giving patients faster, more convenient access to care—especially for issues like back pain, joint stiffness, or post-surgical recovery. However, Medicare operates under a federal program, and its payment rules are separate from state licensure laws.
The Medicare program does not formally recognize direct access for outpatient physical, occupational, or speech therapy services. This means Medicare requires specific documentation from a physician or nonphysician practitioner (NPP) to reimburse therapy services, even if state laws allow direct access. But that doesn’t mean you can’t start therapy. If your state allows direct access, a Medicare beneficiary can be evaluated by a therapist without a referral.

Medicare doesn’t officially recognize direct access the way private insurance might, but that doesn’t mean you can’t start therapy without a referral. The key is making sure all necessary documentation and physician certification are in place to ensure coverage.
¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at https://physicaltherapynow.com/franchise/

Physical Therapy Now was founded in 2015 by visionary entrepreneur Andy Zapata in Miami, Florida, born from a simple yet powerful mission: to restore movement, function, and hope for people of all walks of life. As a seasoned healthcare executive and advocate for underserved communities, Andy understood the profound impact that quality rehabilitative care can have—not just on individuals, but on families and communities as a whole.

The concept for Physical Therapy Now was developed through hands-on experience. Andy opened and operated five highly successful clinics across South Florida, each one serving as a testament to a model that combined evidence-based care with personalized attention, operational excellence, and culturally competent service. These clinics quickly earned a reputation for putting patients first, reducing pain, improving quality of life, and helping individuals regain their independence with dignity and compassion.

Recognizing the growing demand for accessible, high-quality physical therapy services—and driven by the success of these initial locations—Andy decided to expand the impact of his proven model through franchising. Thus, in the same year of its founding, Physical Therapy Now began its journey as a franchise company, empowering other entrepreneurs and healthcare professionals to bring the same level of care to their own communities.

Since its inception as a franchise, Physical Therapy Now has grown to include more than 50 locations across three states, including Florida and Texas. This growth has been fueled not just by market demand, but by a deeply rooted commitment to operational support, clinical excellence, and a strong community ethos. Franchise owners are supported with comprehensive training, marketing strategies, billing and compliance systems, and ongoing mentorship to ensure they succeed—not only as business owners but as healthcare leaders.

Today, Physical Therapy Now stands as a symbol of resilience, innovation, and accessibility in rehabilitative care. Each clinic operates with a consistent mission: to provide life-changing services to patients while building meaningful relationships within the communities they serve. Whether helping someone recover from surgery, manage chronic pain, or improve mobility after an accident, every therapist and support team member is driven by a common purpose: to help people live healthier, more active lives.

As Physical Therapy Now continues to grow, the vision remains clear—to become the most trusted name in physical rehabilitation across the United States, delivering exceptional care while uplifting the communities that need it most. Guided by its core values—Patients First, Teamwork with Heart, and Now Matters—the company is more than a network of clinics. It is a movement, redefining what it means to care in the modern age.

Pain is something most of us experience at some point in life. But not all pain is the same. Some types come on suddenly and go away quickly, while others linger for months or even years. Understanding the difference between acute and chronic pain is key to managing your health—and physical therapy can play a major role in treating both.

Acute pain is short-term pain that usually comes on suddenly and is directly related to a specific injury, illness, or event. It acts as a warning sign from your body that something is wrong. Common causes of acute pain include sprained ankle, post-surgical pain, back strain from lifting something heavy. Acute pain typically lasts a few days to a few weeks, depending on the cause. As the body heals, the pain gradually goes away.
Chronic pain lasts longer—usually 12 weeks or more, even after the original injury or condition has healed. It may start as acute pain but persist due to nerve involvement, inflammation, or other complex changes in the body’s pain signaling system. Chronic pain can interfere with sleep, mood, physical activity, and overall quality of life. Common causes of chronic pain include arthritis, fibromyalgia, long-term back or neck pain and nerve damage. Whether you’re dealing with a sudden injury or struggling with long-term pain, physical therapy offers a safe, drug-free, and highly effective solution. By targeting the source of your pain and teaching you how to move better, PT helps you recover faster, stay stronger, and feel more in control.

Understanding Two Powerful Paths to Pain Relief and Healing

When you’re dealing with back pain, neck stiffness, or recovering from an injury, you might wonder:
Should I see a physical therapist or a chiropractor? The good news is, both physical therapy and chiropractic care are valuable, non-surgical options for addressing pain, restoring function, and improving your quality of life. But they take different approaches — and knowing the difference can help you choose the care that’s right for you. Physical therapy (PT) focuses on helping patients restore movement, strength, balance, and function after injury, illness, or surgery. PTs use scientifically based techniques to treat the underlying cause of pain or dysfunction. Physical therapy is often used after surgeries, sports injuries, strokes, or chronic conditions like arthritis. It’s a progressive, functional approach focused on helping you get back to your normal activities — or better than before.

Chiropractic care is a healthcare discipline that focuses on diagnosing and treating mechanical disorders of the spine and musculoskeletal system, especially misalignments (called subluxations). Chiropractors aim to restore proper spinal alignment, improve nerve function, and relieve pain — especially back and neck pain, headaches, and joint discomfort. Care often involves regular adjustments to maintain alignment over time. Some clinics even offer collaborative care, where PTs and chiropractors work together to get you faster results.
Both professions are dedicated to helping you live pain-free — just through different approaches.

As healthcare reimbursement continues to decline and operational costs rise, many organizations are searching for ways to optimize billing and increase revenue per outpatient therapy visit. One question we’ve heard more frequently is: “Can a hospital bill HCPCS code G0463 every time a patient receives outpatient physical, occupational, or speech therapy?” To help clarify this issue, we’re breaking down what G0463 represents, when it can be billed, and why it does not apply to therapy-specific revenue codes. According to the 2025 HCPCS Level II coding manual, G0463 is defined as: “Hospital outpatient clinic visit for assessment and management of a patient.” This code is used by hospitals to report clinic visits where evaluation, treatment planning, and coordination of care occur in a hospital outpatient setting.

Hospitals are allowed to bill G0463 for outpatient clinic visits that involve assessment and management services. These are typically medical or primary care-related appointments, not therapy services. To be valid, G0463 must be paired with a supporting revenue code that aligns with clinic or evaluation-type services. Hospitals should not bill G0463 when a patient attends an outpatient therapy session for physical, occupational, or speech therapy. The revenue codes associated with therapy services (042x, 043x, 044x) are not aligned with the clinic-based evaluation and management services required for billing G0463. Trying to bill G0463 in this context could lead to denials, compliance issues, or audit risk. As hospitals and therapy clinics navigate financial pressures, it’s important to optimize billing within the rules. While G0463 can be a valid code for hospital-based outpatient clinic visits, it does not apply to therapy services billed under the appropriate therapy revenue codes.

Un enfoque culturalmente sensible para el bienestar y la independencia. En nuestras comunidades latinas, los adultos mayores son pilares fundamentales de nuestras familias. Son abuelos, madres, padres, y sabios consejeros. Y como tal, merecen una vida activa, saludable y digna.

Pero con los años, es común experimentar dolor, rigidez, caídas, o pérdida de movilidad. La buena noticia es que la terapia física puede ayudar a prevenir estos problemas y mejorar la calidad de vida, todo sin necesidad de medicamentos invasivos o cirugías costosas.

En Physical Therapy Now, entendemos las necesidades físicas, emocionales y culturales de nuestros adultos mayores latinos. Aquí te contamos cómo la terapia física puede marcar una gran diferencia. La terapia física no es solo para atletas o personas que han tenido una cirugía. Para los adultos mayores, es una herramienta poderosa que mejora el equilibrio y previene caídas, fortalece músculos débiles y mejora la movilidad, reduce el dolor crónico, como el de rodillas, espalda o artritis, ayuda a recuperar la independencia para caminar, cocinar o cuidar a los nietos y promueve la salud mental y emocional al mantenerse activo y conectado.
En Physical Therapy Now, muchos de nuestros terapeutas y personal hablan español y entienden nuestra cultura. Sabemos que no se trata solo del cuerpo,también tratamos con respeto, calidez y paciencia. Nos tomamos el tiempo para explicar, escuchar y apoyar en cada paso del proceso. Cuando nuestros pacientes se sienten como en casa, los resultados son mejores. Aquí no solo sanamos cuerpos, tambien fortalecemos espíritus.

Si usted o alguien que conoce necesita terapia física, por favor llámenos al 305-570-1633.
Si está interesado en abrir una franquicia de Physical Therapy Now, envíenos un correo a franchise@physicaltherapynow.com o visite nuestro sitio web en https://physicaltherapynow.com/franchise/

One of the most common questions we hear at Physical Therapy Now is:
“Do I need a referral from my doctor to start physical therapy?”

The answer depends on where you live and your insurance plan—but in many cases, the answer is: NO, you don’t!
Thanks to something called Direct Access, patients in many states can go straight to a licensed physical therapist without needing a physician’s referral. Direct Access means you have the legal right to seek evaluation and treatment from a physical therapist without a referral from a doctor or specialist. It’s designed to give patients quicker access to care—especially important when you’re in pain or recovering from an injury. As of now, all 50 U.S. states allow some form of Direct Access, although the rules vary slightly from state to state. Skipping the referral process can save you time (no waiting for another doctor’s appointment), start your recovery sooner and reduce out-of-pocket expenses,especially if a doctor visit would cost you extra. It puts you in control of your health and recovery without unnecessary delays.

Even though Direct Access is allowed in many cases, your insurance plan might still require a referral or prescription to approve coverage. Here’s when you might need one: If your insurance mandates a referral for reimbursement, if you’re covered by Medicare, which often requires documentation from your physician and if your state has restrictions. You don’t always need a doctor’s referral to start physical therapy—and that’s great news if you’re ready to feel better, move better, and get back to doing what you love. Thanks to Direct Access, many patients can begin treatment right away.

404!

Contact

Hours

404!

Contact

Hours

Cookies on physicaltherapynow.com