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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.

Introduction: Becoming a Physical Therapy Entrepreneur
The field of physical therapy is rapidly evolving. Private practice owners and physical therapists are facing new challenges every year—declining reimbursements, rising costs, stricter compliance standards, and the increasing need to innovate in patient care and business operations. But within these challenges lies opportunity.
This book is designed to help physical therapists, clinic owners, and aspiring PT entrepreneurs learn how to build, grow, and sustain a thriving practice. It is based on the proven strategies of Physical Therapy Now, a franchise built on the vision of empowering clinicians to deliver quality care while building successful businesses.
Here, we will cover the mindset, tools, and systems needed to not only survive but thrive as a PT entrepreneur.
Chapter 1: The Rise of the PT Entrepreneur
Physical therapists are no longer limited to working under hospitals or physician-owned practices. More and more clinicians are taking control of their careers by opening independent practices. These PT entrepreneurs understand that they can deliver excellent care, while also building a business that supports their families and communities.
Unlike traditional entrepreneurs, PT entrepreneurs carry the dual responsibility of healing patients and running a business. This requires unique skills: clinical excellence, leadership, and business acumen.
Signs you may be ready to step into PT entrepreneurship include:
• A passion for patient care beyond the standard model.
• A desire to set your own schedule and systems.
• Interest in learning business operations like billing, compliance, and marketing.
• A drive to create something bigger than yourself—something that impacts your community.

Chapter 2: Finding Your Niche in Physical Therapy
One of the biggest mistakes new PT owners make is trying to serve everyone. The most successful practices focus on a niche. This could be:
• Sports rehabilitation (athletes, weekend warriors)
• Workers’ compensation and injury recovery
• Personal injury cases (auto accidents, attorney referrals)
• Geriatric care and balance therapy
• Specialized therapy programs (e.g., women’s health, pediatric PT)
By creating a specific focus, you:
• Differentiate yourself from competitors.
• Attract patients who need your specialized expertise.
• Build referral networks with physicians and attorneys who know your niche.
At Physical Therapy Now, we guide franchisees in identifying niches that align with their passion and market demand.

Chapter 3: Work Smarter, Not Harder in Clinic Operations
Running a practice can quickly become overwhelming. Successful PT owners know how to prioritize and delegate.
Key Strategies:
• Use EMR/EHR systems wisely: Tools like IKON EMR (our proprietary system) simplify documentation, billing, and compliance.
• Delegate non-clinical tasks: Hire front desk staff or use virtual assistants for scheduling, insurance verification, and follow-ups.
• Automate processes: Patient reminders, online intake forms, and automated billing save hours each week.
• Focus on your unique role: Your highest value is in patient care and leadership—not in chasing claims or managing endless paperwork.

Chapter 4: Consistency in Patient Care & Clinic Operations
Consistency creates trust—with patients, staff, and referral sources.
To maintain consistency:
• Establish daily routines (patient flow, documentation, team huddles).
• Develop clear protocols for evaluations, treatment plans, and progress reports.
• Use KPIs (Key Performance Indicators) to track revenue, visits, patient satisfaction, and referral growth.
• Train staff regularly on customer service and compliance.
Patients who see consistent results become your best marketers through word-of-mouth and online reviews.
Chapter 5: Building Referral Networks
Referrals are the lifeblood of a PT practice. While digital marketing helps, relationships drive growth.
Referral Strategies:
• Physicians: Build trust by sending clear progress notes and demonstrating excellent outcomes.
• Attorneys: For personal injury cases, show reliability, timely documentation, and a willingness to communicate.
• Community outreach: Host workshops on fall prevention, sports injury prevention, or back pain relief.
• Social media: Showcase success stories and engage with your local community online.
Networking is not just about handing out business cards—it’s about creating genuine partnerships.
Chapter 6: Investing in Technology & Systems that Scale
As your clinic grows, investing in the right systems is critical. Technology is not an expense—it’s a multiplier.
Smart Investments:
• EMR/EHR systems (IKON EMR for PT Now clinics)
• Billing and RCM services
• Telehealth platforms for remote care
• Home exercise program software for patient adherence
• Marketing automation tools to stay connected with your community
Don’t pay for tools you rarely use. But when a system directly impacts efficiency, compliance, or patient outcomes, it’s worth the investment.
Chapter 7: Growth Over Perfection in Patient Outcomes
Perfection can paralyze progress. PT entrepreneurs must understand that progress is more important than perfection.
• Focus on continuous improvement: Every patient interaction is an opportunity to learn and refine.
• Celebrate small wins: An improved range of motion, fewer headaches, or one step closer to independence is worth recognizing.
• Avoid burnout: Don’t over-analyze or redo systems endlessly—implement, measure, and improve over time.
Your goal is steady progress in both patient outcomes and business growth.
Chapter 8: Preventing PT Burnout & Leading a Balanced Life
Physical therapy is demanding—both emotionally and physically. PT owners must prioritize balance to avoid burnout.
Strategies:
• Set boundaries: Don’t let paperwork consume your nights and weekends.
• Schedule downtime: Protect personal and family time as you would patient
• Delegate leadership: Train clinic managers or lead therapists to handle operations.
• Focus on wellness: Exercise, nutrition, and stress management keep you at your best for patients and your business.
A balanced leader creates a healthy workplace culture.
Conclusion: Leading the Future of Physical Therapy with PT Now
Becoming a physical therapy entrepreneur is not just about owning a clinic—it’s about leading change in healthcare. At Physical Therapy Now, we believe every therapist has the potential to make an impact in their community while building a successful business.
By focusing on niche care, operational efficiency, referral networks, technology, growth over perfection, and balance, you can create a thriving clinic that delivers excellent care and sustainable business success.
The future of physical therapy is in the hands of bold clinicians who are ready to take control. With the right mindset and systems, you can be one of them.

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.

Whether you’re a weekend warrior, a high school athlete, or a pro competing at the highest level, an injury can be one of the most frustrating setbacks. It doesn’t just affect your body, it takes a toll on your confidence, your performance, and sometimes your identity. But here’s the good news: physical therapy is one of the most powerful tools available to get you back in the game stronger, smarter, and safer than before.
Return to sport isn’t just about being pain free or cleared by a doctor. It’s about being physically and mentally ready to perform at your pre injury level or higher without risking re-injury.

A structured return to sport program focuses on:
Full range of motion and strength restoration
Sport specific movements and agility
Cardiovascular fitness and endurance
Mental readiness and confidence
Prevention of future injuries

Physical therapists design customized plans that replicate the specific movements and intensity of your sport, whether it’s sprinting, pivoting, swinging, or jumping. Injury often leads to muscle atrophy, weakness, and imbalances. The Physical Therapy will guide the patients through a progressive strengthening program, starting with controlled movements and gradually building to high load, explosive exercises that reflect the game-day performance.

The recommendation is to start as soon as possible, cause early intervention leads to faster healing, fewer complications, and a more efficient return to play timeline. Whether you’ve had surgery, suffered a sprain, or just feel “off,” a physical therapist can evaluate your condition and start you on a smart path to recovery.

In an important policy update, the Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy Manual to clarify and tighten the qualifications for speech language pathologists, delivering outpatient therapy services to Medicare beneficiaries. The change has significant implications for Clinical Fellow SLPs, especially in billing and service delivery across all outpatient settings.
As of April 18, 2025, Centers for Medicare & Medicaid Services has removed language from Section 230.3 of the manual that previously allowed clinical fellows to treat Medicare patients under supervision. The revised language now requires all SLPs billing Medicare outpatient therapy services to fully meet licensure and post graduate experience requirements, effectively disqualifying CFs with provisional licenses from treating Medicare outpatients.

To be recognized as a qualified provider of outpatient speech therapy services under original Medicare, a speech language pathologist must:
– Hold a Master’s or Doctoral degree in speech-language pathology (since Jan 1, 2015)
– Be licensed by the state in which services are provided

In states without licensure:
-Complete 350 supervised clinical hours
-Complete 9 months of supervised, full-time practice post-degree
-Pass a national examination approved by HHS

The American Speech Language Hearing Association is currently in communication with CMS. The American Speech Language Hearing Association is actively advocating for the recognition of provisional licensees as qualified Medicare providers. Their goal is to reverse the policy change and allow CF SLPs to participate in Medicare outpatient services under defined conditions.
This 2025 CMS update brings major implications for staffing, billing, and supervision in outpatient speech therapy. While it enhances clarity on qualifications, it also limits the flexibility of practices employing CFs. At Physical Therapy Now, we remain committed to delivering compliant, high-quality care and supporting our therapists through evolving regulations.

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.

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