Understanding how often you can submit claims for outpatient therapy services depends largely on the classification of your practice or organization. This blog explores the guidelines for submitting claims to both Medicare and commercial insurance carriers and clarifies which therapy settings are eligible for daily submissions versus monthly submissions.

Outpatient therapy services can be provided in various settings, including private practices (therapist or physician-owned), Outpatient Rehabilitation Facilities (ORFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and hospital outpatient departments. However, not all these settings follow the same billing rules.

For Medicare claims, settings that submit on a CMS-1500 claim form—like private practices and certain hospital therapy departments—can submit claims daily to their Medicare Administrative Contractor (MAC). In contrast, settings that use the UB-04 claim form—like ORFs, CORFs, SNFs, HHAs, and most hospital outpatient departments—must submit claims monthly or after the conclusion of services within a given month. When billing commercial insurance carriers, the rules are similar. Organizations using the 1500-claim form (such as private practices and non-provider-based hospital departments) can generally submit claims daily. However, those submitting via UB-04 (such as SNFs, HHAs, and standard hospital outpatient departments) must follow monthly submission protocols.

¨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 www.physicaltherapynow/franchise¨

404!