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.

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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.

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What you need to know before starting treatment. If you’re considering physical therapy to recover from an injury, manage chronic pain, or improve mobility, you might be wondering: “Is physical therapy covered by my insurance?” The good news is that in most cases, yes. Most major health insurance plans—including Medicare, Medicaid, and private insurers like Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield—do cover physical therapy services. Coverage usually depends on:
Medical necessity

A referral or prescription from your doctor

Your plan’s deductible and copayments

Depending on your insurance plan and state laws: Some plans require a referral from your primary care doctor or a specialist. Others allow direct access, meaning you can schedule an evaluation with a physical therapist without a referral. In the clinic, the front desk person always verifies your coverage and referral requirements before your first visit—so there are no surprises. If you don’t have insurance, that doesn’t mean you can’t get care. Here at Physical Therapy Now, we offer: Affordable self-pay rates, discounted therapy packages, flexible payment plans. Your health shouldn’t have to wait because of coverage issues. Our goal is to make your experience easy, affordable, and stress-free. If you’ve been putting off therapy because of insurance questions, we’re here to help.
Call your nearest Physical Therapy Now clinic and we’ll walk you through your benefits, coverage, and options—so you can start your recovery journey today.

¨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/¨

As a private practice owner who has chosen to operate out-of-network (OON) with insurance companies, one of the most important billing decisions you’ll face is whether to submit claims to insurers on behalf of your patients or provide them with a superbill for self-submission. If you decide to submit the claim yourself, you have two options: accept assignment or not accept assignment. Accepting assignment means the insurer pays you directly for the portion they cover, and the patient pays only their cost-sharing amount (copay or coinsurance). However, keep in mind that insurers aren’t required to honor assignment and may still send the payment to the patient. If you choose not to accept assignment, the patient pays your full rate upfront, and the insurer reimburses them directly for the covered portion—this is common with PPO plans but may not apply to Medicare Advantage or TRICARE plans. Alternatively, if you don’t want to submit any claims at all, you can either give the patient a superbill or simply charge your cash rate and provide no documentation for reimbursement. A superbill is an itemized receipt that includes essential details like diagnosis codes (ICD-10), service codes (CPT), charges, provider and therapist information, and patient identifiers. This allows the patient to seek reimbursement directly from their insurance carrier.

¨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¨

The Future of Physical Therapy Franchising

The ability to influence the physical therapy franchising industry is largely dependent on the individual’s level of professional knowledge, experience, and expertise in the field. Additionally, having a strong network of industry professionals, as well as building strong relationships with key decisionmakers in the industry, are important factors in the ability to influence the physical therapy franchising industry. Lastly, having a strong understanding of the current market trends and financials of the industry can also help an individual to influence the industry.

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