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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.

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.

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/

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.

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.

When a therapist—whether a full-time employee or a traveling clinician—leaves a practice, it’s not uncommon to discover unfinished documentation, such as a missing discharge report. One of the most frequently asked questions in this scenario is whether another therapist who never treated the patient can write the discharge report based solely on the existing notes in the medical record. Technically, the answer is yes—another licensed therapist could write the discharge summary. However, the real question is: should they?

Any therapist who signs their name and credentials on a discharge report becomes part of that patient’s case, regardless of whether they ever interacted with the patient directly. This can present several concerns. If an insurance company requests the records, or if the patient has an active workers’ compensation claim, pending lawsuit, or any other legal matter related to their care, the therapist who authored and signed that report could be pulled into the case. Without firsthand knowledge of the patient’s condition, progress, and outcomes, the substitute therapist may be at a disadvantage in justifying the clinical decisions or summarizing the treatment provided. While it’s permissible for a different therapist to write the discharge report based on existing documentation, it’s important to weigh the potential risks. Ideally, the therapist who evaluated and treated the patient should complete the discharge report. If that’s not possible, practices should implement a clear policy and ensure thorough internal documentation to protect both clinicians and the integrity of patient care.

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