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.

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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.

¨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/

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