Brace Health resources
Practical guidance authored by the people who work on billing and practice operations every day.
5 resources
A waitlist does not guarantee negotiating leverage or a rate increase. It may help a physical therapy practice document an access need in its market; a payer-specific case should connect that evidence to network adequacy or a plausible near-term cost alternative.
Published
For applicable Medicare Part B outpatient physical therapy services, a service furnished in whole or in part by a PTA may require the CQ modifier when the PTA’s independent portion exceeds the de minimis threshold. For claims subject to the reduction, Medicare pays 85% of the otherwise applicable amount. Verify the current CMS rule and claim circumstances before billing.
Updated
A delay between a completed therapy visit and claim submission can postpone reimbursement and leave less time to correct problems before a payer’s filing deadline. Track the visit-to-submission handoffs, identify the first stalled step, and verify the actual deadline for each payer rather than assuming one universal limit.
Updated
Medicare Physician Fee Schedule amounts can vary by procedure code, payment year, and locality. Use CMS’s lookup with the right code and locality, then check payment indicators and claim-specific rules; a displayed fee-schedule amount is not a guarantee of the final payment.
Updated
A PT practice can prepare a stronger rate request by connecting a focused ask to evidence the specific payer may value, such as specialized access, network adequacy, or near-term cost. The case and likely outcome vary by payer and market.
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