Denial appeals · Physical & occupational therapy
PT clinics lose more to denials than almost any specialty. It's also the most winnable revenue in healthcare.
Therapy claims get denied on volume: medical necessity on timed codes, visit caps, unit disputes, plan-of-care technicalities. Each one is small enough that nobody appeals it — which is exactly why payers keep denying. We make appealing them free until they pay.
Free for your first 10 claims. Then 15% of recovered revenue only — upheld denials cost you nothing.
The denials you're seeing
We know these EOBs by heart.
| Denial | What the payer said | Why it's often winnable |
|---|---|---|
| CO-50 | Not medically necessary (97110, 97140, 97530) | Payer therapy policies have objective criteria — functional deficits, measurable progress. Your eval and daily notes usually meet them; the denial usually ignores them. |
| CO-151 | Frequency / visit limit exceeded | Plan caps frequently have medical-exception provisions, and 'soft caps' get applied as hard denials. We force the distinction. |
| CO-97 | Bundled — e.g., 97140 with 97530 | NCCI edit disputes turn on the 59/X modifiers and distinct-service documentation. Technical denials are winnable denials. |
| CO-16 | Missing/invalid info — POC certification, signatures | Often a correctable defect: late physician certification or a missing signature date. We identify the exact cure and convert write-off to resubmission. |
| CO-29 | Timely filing | Clearinghouse acceptance reports prove original submission. Good-cause exceptions exist in nearly every payer manual. |
How we fight them
Specialty-specific arguments, not form letters.
Unit-count disputes
When payers down-adjust units on timed codes, the math in your flowsheet is the evidence. We rebuild the minutes-to-units calculation into the appeal so the reviewer has to engage with it.
Technicality reversals
Late certifications and recert gaps cause denials that feel unwinnable. Delayed-certification provisions and retroactive physician attestation fix more of these than most billers expect.
Medical-necessity wins
We map your objective measures — ROM, strength grades, functional outcome scores — directly onto the payer's own coverage criteria, line by line.
Free 10-claim pilot
Find out what your write-offs were actually worth.
Tell us a little about your practice. We'll reply within one business day with the BAA and a secure upload link.