Specialties
Billing rules change with the specialty
For each specialty, we write down its billing rules, turn them into checks and test them before it goes live. Physical therapy is live. Tell us your specialty if you bill something else.
Where each specialty stands
| Specialty | Status | What is different about billing it | Next step |
|---|---|---|---|
| Physical therapy | LiveLive for physical therapy practices. | Units from treatment minutes under the 8-minute rule, GP on every line, KX above Medicare's $2,480 amount (2026)1, CQ when an assistant treats, and certified plans of care. We code and check all of it. | Read the physical therapy page |
| Occupational therapyBilling rules | By request | The same timed codes as PT, with its own evaluation codes (97165 to 97168), the GO modifier, its own $2,480 KX amount (2026) and CO for OT assistants.2,1 | Tell us your specialty |
| Speech-language pathologyBilling rules | By request | The CPT code set replaces the main treatment code, 92507, with timed codes from January 1, 2027; Medicare has proposed how it will pay them. GN modifier. Shares Medicare's KX amount with physical therapy.3,4,1 | Tell us your specialty |
| Behavioral healthBilling rules | By request | Psychotherapy codes follow session length (16 to 37, 38 to 52, 53 or more minutes), and crisis codes cannot be billed with other psychotherapy codes.5,6 | Tell us your specialty |
| Family and internal medicineBilling rules | By request | Visit level follows medical decision making or time. Modifier 25 and G2211 have their own rules. Medicare covers a wellness visit once every 12 months but not a routine physical.7,8,9 | Tell us your specialty |
| PediatricsBilling rules | By request | Practices cannot charge for vaccines from the Vaccines for Children program, only fees such as administration.10 | Tell us your specialty |
| ChiropracticBilling rules | By request | Medicare pays only for manual manipulation of the spine to correct a subluxation, with the AT modifier for active treatment. Maintenance care is not paid.11 | Tell us your specialty |
| PodiatryBilling rules | By request | Routine foot care is covered only with qualifying findings, shown with the Q7, Q8 or Q9 modifier.12 | Tell us your specialty |
| DermatologyBilling rules | By request | Biopsy codes depend on the technique used.13 | Tell us your specialty |
| Obstetrics and gynecologyBilling rules | By request | Maternity care is billed as a global package today. The CPT maternity codes change in 2027; Medicare has proposed how to apply them.4 | Tell us your specialty |
| Other specialties | By request | Tell us what you bill and who bills it today. | Tell us your specialty |
What the labels mean
| Label | What it means |
|---|---|
| Live | We bill this specialty today. Its billing rules are on its page, with the source for each. |
| By request | Tell us your specialty, and your billing plan sets out how we will bill it. |
How we add a specialty
A physical therapy claim depends on minutes, units and a signed plan of care. A psychotherapy claim depends on session length. A dermatology claim depends on the procedure. A biller who knows physical therapy well can still get dermatology wrong. So every specialty goes through the same steps before it goes live.
We write down the rules
We collect the specialty's billing rules from public sources: Medicare's manuals and code edits, the CPT code descriptions, and the written policies of the insurance companies your practice bills. Each rule gets a plain description, its source and the date we checked it.
We turn each rule into a check
Every claim has to pass every check before it goes out. A failed check stops the claim and sends it to one of our billing specialists, not to the insurance company.
We test the checks
We build test claims that should pass and test claims that should fail, and run every check against them. What fails gets fixed and tested again.
We build and test the billing checks for each specialty before we bill it. Physical therapy is live.
The same scope in every specialty
The parts of billing we run, check or track are the same for every practice. What changes by specialty is the rules each claim is checked against.
The full scope, line by line- Coding and charge reviewIncluded
- Claim scrubbing and submissionIncluded
- Payment postingIncluded
- Denials and appealsIncluded
- Accounts receivable (A/R) follow-upIncluded
- Patient statements and callsIncluded
- Live dashboard and monthly summaryIncluded
- Eligibility and benefitsAutomated check only
- Prior authorizationTracking only
- Credentialing and payer enrollmentNot included
Tell us your specialty
Tell us your specialty, your EMR and how many providers you have. We tell you plainly how we will bill your specialty. Please do not include patient information.
Questions about specialties
Billing rules differ by specialty, so we build and test the checks for each one before we bill it. Physical therapy is live.
Specialty focus is common: in Tebra's surveys of billing companies, the share highly focused on specific specialties rose from 43% in 2023 to 57% in 2025.16
Both are by request. Tell us about your practice, and your billing plan sets out how we will bill them.
Next question: what exactly do you do?
Every part of billing we run, what we check or track, and what stays with your practice.