Business | Physicaltherapynow.com

Billing for pediatric therapy can often feel like walking through a maze, especially when it comes to CPT code 97112 (neuromuscular reeducation). Many providers have run into the frustrating reality that some insurers reimburse for this code in pediatric cases, while others deny it outright. In this blog, we’ll break down what CPT 97112 means, why coverage varies, and what therapists can do to navigate these challenges.

According to the American Medical Association 2025 CPT Professional Edition, the code is defined as:
97112 – Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.
In simpler terms, this code is used when a therapist helps a patient retrain the brain and body to work together again, improving posture, coordination, and movement patterns.
Will Insurers Reimburse 97112 for Pediatric Patients?
Here’s the truth: sometimes they do, and sometimes they don’t.

✅ Some insurers reimburse for 97112 when provided to children.

❌ Others deny coverage for pediatric claims under this code.

Unfortunately, there’s no universal rule. Each insurer writes its own policies, which means the only reliable way to know is by checking with the carrier directly.
For children with developmental delays or congenital conditions, therapy often focuses on habilitation. Insurers argue that because the child never had the skill, you can’t “reeducate” it. Therefore, they sometimes deny 97112 as inappropriate for pediatric habilitative therapy.

From a provider’s perspective? This reasoning feels like splitting hairs, and it denies children access to services they clearly need.
Even if an insurer won’t pay for 97112 in pediatrics, therapists still work on the same underlying skills—balance, coordination, proprioception, and posture—within their sessions. The key is in how you document and code:

Document habilitation goals clearly: focus on skill acquisition (learning for the first time) versus skill reacquisition.

Use appropriate codes or modifiers: many payers want habilitative modifiers such as –SZ, –96, or –97 when billing pediatric cases.

Verify benefits up front: before treatment, confirm with the insurer what they cover for habilitation so families aren’t caught off guard.

CPT 97112 is a valuable code for therapy services, but its use in pediatrics can be tricky. Some insurers cover it, some don’t, and the distinction often hinges on semantics.

As a provider, your best tools are:
-Careful documentation
-Smart coding
-Consistent communication with payers

At the end of the day, while the system may not be perfect, you can still make sure children get the therapeutic care they need by navigating billing rules strategically.

When you are in pain or unsure about the extent of your injury, waiting weeks for answers is not an option. That’s why knowing where to get an MRI (Magnetic Resonance Imaging) quickly and affordably is essential.
If your doctor recommends an MRI, MRI Now is your go-to solution. MRI Now is partner with licensed imaging centers across the region to schedule quick, high-quality MRIs, often with same-day or next-day availability.

💡 Why Choose MRI Now?
✅ Same Day or Next Day Scheduling
✅ Convenient Locations Across Florida
✅ No Hassle Insurance Assistance
✅ Top Radiologists & State-of-the-Art Equipment
✅ Affordable Self-Pay Options Available
📍 Get Scanned. Get Answers. Get Back to Life.
Don’t wait weeks. Get the clarity you need today.

🌐 Visit: https://mrinowmiami.com/

At Physical Therapy Now, delivering exceptional, efficient, and compliant care isn’t just a goal, it’s the standard. That’s why we have chosen IKON EMR as our exclusive electronic medical record (EMR) and practice management platform across all our locations.
If you’re looking for the best, most trusted software for physical therapy practices in 2025, IKON EMR is the best software solution trusted and used by the clinics.

IKON EMR was custom-developed for the unique workflow of physical therapy, occupational therapy, and rehabilitation clinics. It’s not a repurposed general EMR, it’s designed specifically to match how therapists think and treat. It is built for therapy, not just medicine. With built-in templates, smart charting, and auto-populated fields, IKON EMR lets clinicians complete daily notes, evaluations, and progress reports faster, without sacrificing accuracy or compliance.

IKON EMR includes real time eligibility checks, insurance verification, automated billing, and robust claims management, all from the same dashboard. No more toggling between systems, the schedule, documentation, and payments live in one seamless flow. IKON uses AI-powered analytics to flag compliance risks, track progress toward goals, and monitor therapist productivity, helping Physical Therapy Now stay ahead of audits, authorizations, and payer policies.

If you’re a physical therapy provider looking to modernize your operations, stay compliant, and put more time back into patient care, IKON EMR is the system we trust, and the one you should too. If you or someone you know is interested in Electronic software services, please visit this website at https://ikonehr.com/

The Centers for Medicare and Medicaid have officially reversed its prior interpretation that excluded Clinical Fellowship and Speech Language Pathologists holding provisional licenses from billing Medicare. Now, provisional or temporary license holders (including Clinical Fellowship and Speech Language Pathologists) are eligible to bill Medicare Part B for outpatient speech language pathology services so long as they meet their state’s licensure/license in process requirements.
The revised guidance defers to each state’s licensing process to determine whether provisional licensees can practice, aligning with 42 CFR 410.62(a), 42 CFR 484.115(n), and Medicare Benefit Policy Manual Section 230.3
CMS now considers provisional licensees in compliance with federal requirements if they follow their state’s licensure pathway, including temporary licensure tied to supervised experience.
This is great cause now, Clinical Fellowship and Speech Language Pathologists can enroll as Medicare providers, obtain their own NPI, and bill Part B services directly provided their state permits provisional licensing during the Clinical Fellowship year.
The Centers for Medicare and Medicaid policy reversal restores career pathways for newly graduated Speech Language Pathologists and supports access to care for Medicare beneficiaries. Private practices, employers, Clinical Fellowship and Speech Language Pathologists should review state licensure laws and payer policies to ensure compliance while maintaining quality care.

¨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/

In today’s increasingly diverse communities, clinics and private practices are seeing more patients who speak little or no English. This has raised an important and sometimes confusing question: Is a clinic required to pay for an interpreter when a patient requests one?
The short answer is: Yes, if the clinic receives any form of federal funding.

Patients with Limited English Proficiency face significant barriers when accessing healthcare. Miscommunication can lead to poor health outcomes, missed diagnoses, and legal risk. Federal law recognizes this and mandates language access for LEP individuals in certain situations.
Under Section 1557 of the Affordable Care Act and reinforced by the Nondiscrimination in Health Programs and Activities Final Rule (2024), any healthcare provider that receives federal financial assistance is required to provide and pay for qualified interpreter services when needed.
This includes:
-Clinics participating in Medicaid or CHIP
-Clinics billing for Medicare Part B services
-Facilities involved in Medicare Advantage (Part C) or Medicare Part D plans
-Any healthcare provider receiving grants from HHS or participating in ACA Marketplace plans

Using family members or minors as interpreters is strongly discouraged and often noncompliant, as it may compromise accuracy, privacy, and ethics.
Providing interpreter services isn’t just a legal obligation, it’s a commitment to quality care and equity. By ensuring LEP patients can fully understand their care, clinics protect themselves legally and help build trust in the communities they serve.
If you’re unsure whether your clinic qualifies under federal guidelines or how to set up interpreter services, consult with a healthcare compliance expert or legal advisor.

Arthritis is one of the leading causes of pain and disability in the United States, affecting millions of people, especially older adults. If you’re living with arthritis, you know how joint stiffness, swelling, and pain can disrupt your daily life. While medication can offer relief, many people prefer to manage their arthritis naturally, without relying on long-term drug use. The good news about that is that Physical therapy offers powerful, drug-free solutions to reduce arthritis pain, restore mobility, and improve your quality of life.

Arthritis is not just one condition, it’s a general term for joint inflammation. The most common types include:
-Osteoarthritis: “Wear and tear” arthritis that breaks down cartilage over time.
-Rheumatoid Arthritis: An autoimmune disease causing joint inflammation and damage.
-Psoriatic Arthritis, Gout, and others also affect joints and surrounding tissue.

No matter the type, arthritis can cause pain, stiffness, and decreased range of motion. Movement is medicine for arthritis. A licensed physical therapist will create a tailored exercise plan to increase joint flexibility and range of motion, build muscle strength to support weak joints, improve balance and stability and reduce joint stress during daily activities. Gentle exercises like stretching, resistance training, and aquatic therapy are often included. The benefits are no side effects from medications, better balance and fewer falls and a stronger sense of control over your health.
You don’t have to rely solely on medication to manage your arthritis. Physical therapy offers a safe, effective, and personalized way to relieve pain, move better, and regain your freedom naturally.

If you or a loved one is struggling with arthritis, let our physical therapists help. Contact Physical Therapy Now to schedule your evaluation and start your journey toward pain free living today.

In a recent update, the Centers for Medicare & Medicaid Services (CMS) has made a significant change that impacts how hospital outpatient therapy departments bill and receive reimbursement for Remote Therapeutic Monitoring (RTM) services. Understanding this change is essential for accurate billing and ensuring proper reimbursement, especially as Remote Therapeutic Monitoring becomes a growing part of modern therapy care.
Centers for Medicare and Medicaid Services are changing the Status Indicator for two key CPT codes used in Remote Therapeutic Monitoring:

CPT 98980 – RTM treatment management services, 1st 20 minutes

CPT 98981 – Each additional 20 minutes of RTM treatment management

These codes are shifting from status indicator B to status indicator A. The status indicator B is not reimbursed under the Outpatient Prospective Payment System when billed by hospitals on a UB-04 claim (Bill Types 12x or 13x). The satus indicator A now separately reimbursable under the Medicare Physician Fee Schedule, but still not reimbursed under OPPS for hospitals. So, CPT 98980 and 98981 are now payable, but only under the physician fee schedule, not OPPS. Hospitals billing under the OPPS must route these claims through the correct billing channels to receive reimbursement. This change is retroactive to January 1, 2025. That means any claims with dates of service on or after 1/1/25 should follow the new billing rule.
This change by CMS reflects the ongoing shift in how technology driven services like Remote Therapeutic Monitoring are integrated and reimbursed across healthcare settings. While RTM continues to offer tremendous value for physical therapy patients, providers must be vigilant with billing accuracy to ensure reimbursement under evolving Medicare rules.

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’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.

404!

Contact

Hours

404!

Contact

Hours

Cookies on physicaltherapynow.com