Outpatient physiatry clinics
Combining E/M visits, injections and therapy referrals.
PM&R billing & RCM · California
Physical Medicine & Rehabilitation (PM&R) Billing Services in California
California Billing Services provides physical medicine and rehabilitation (PM&R) billing services for physiatrists and rehabilitation practices across California. Our coders bill every PM&R service line: office and hospital visits, EMG and nerve conduction studies, chemodenervation, spine and joint injections, inpatient rehabilitation and outpatient therapy. We submit and follow up on claims with Medicare, Medi-Cal, commercial plans, workers' compensation carriers and personal injury attorneys, so your practice is paid for every service it documents.
Share recent claims and we can show you where revenue is leaking.
HIPAA safeguards and BAACoders trained in PM&RWorks inside your EHR and practice management system
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2026 Medicare KX threshold (PT/SLP combined; OT separately)
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Level above which Medicare may review therapy claims
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2026 Medicare Advantage decision time for urgent prior authorizations
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Window to request workers' comp second bill review
Direct answer
What is PM&R billing?
PM&R billing is the coding, claim submission and payment follow-up for services from physiatrists and rehabilitation teams. It covers office and hospital visits, electrodiagnostic testing, chemodenervation, injections and therapy. Each has its own codes, modifiers, unit rules and authorization requirements, so a small error can cost a practice payment for care it fully documented.
Who we serve
Billing support for every kind of PM&R practice
Physiatry covers more ground than almost any other specialty, so we set up billing around how your practice actually works.
Interventional spine and musculoskeletal practices
Performing epidurals, facet injections and radiofrequency ablation.
Neurorehabilitation and spasticity clinics
Treating stroke, brain injury, spinal cord injury and cerebral palsy.
Electrodiagnostic labs
Performing EMG and nerve conduction studies.
Inpatient rehabilitation physician groups
Rounding in IRFs, acute hospitals and skilled nursing facilities.
Multidisciplinary rehab practices
With in-house PT, OT and speech therapy.
Injury-focused physiatrists
Treating workers' comp and personal injury patients, including QMEs.
Where revenue leaks
Where PM&R practices lose revenue
Most PM&R denials don't come from bad care. They come from rules that change by service line, payer and setting. These are the problems we fix most often.
EMG add-ons billed wrong
Needle EMG add-on codes 95885, 95886 and 95887 are paid only with a nerve conduction study code, and the extremity count must match the report.
Botulinum toxin units and waste
Units that don't match the vial size, a missing JW or JZ modifier, or a dropped guidance code can turn a profitable injection into a loss.
Expired or missing authorizations
Spine procedures, chemodenervation and therapy often need prior authorization, and approvals expire before treatment ends.
Hospital and IRF visits
Medicare doesn't pay consult codes, and inpatient rehab visits must meet frequency and documentation rules.
Therapy thresholds
Claims above the Medicare KX threshold without the KX modifier are denied, and timed codes must follow the 8-minute rule.
Workers' comp delays
Requests for Authorization stall in utilization review, payments come in below the Official Medical Fee Schedule, and second bill review deadlines pass.
Aging personal injury liens
Lien balances sit for months without anyone tracking the case.
Service lines
PM&R services we code and bill
Our coders specialize in the procedures physiatrists perform, not just general medical billing.
Office visit and E/M billing
We level new and established visits (99202–99215) on medical decision making or time, and apply modifier 25 when a significant, separate visit happens on the same day as an injection. Hospital and inpatient consults are billed with codes each payer actually accepts.
EMG and nerve conduction study billing
We bill nerve conduction studies (95907–95913) by the number of studies performed and pair them with the right needle EMG add-on (95885–95887). Standalone needle EMG (95860–95864, 95867–95870) is coded by extremity, and diagnoses such as radiculopathy and carpal tunnel syndrome are matched to Noridian and commercial coverage policies before the claim goes out.
Chemodenervation and spasticity management billing
We code chemodenervation by site (64612, 64616, 64642–64647) and add EMG, electrical stimulation or ultrasound guidance when it's documented. Drug lines carry the right HCPCS code (J0585, J0586, J0587 or J0588), units and JW or JZ modifier. We also bill intrathecal baclofen pump analysis, reprogramming and refills (62367–62370, 95990–95991).
Interventional spine and joint procedure billing
We bill epidural steroid injections, facet joint injections, radiofrequency ablation, trigger point injections and joint injections, including image guidance and laterality modifiers. Authorizations are confirmed before the procedure date, and repeat procedures are checked against payer frequency limits.
Inpatient rehabilitation and hospital billing
We bill initial and subsequent hospital visits for physiatrists in inpatient rehabilitation facilities, acute hospitals and skilled nursing facilities. We flag missing documentation for required face-to-face rehab physician visits so IRF stays hold up in review.
Outpatient therapy billing (PT, OT and speech)
We bill therapy evaluations and timed treatment codes with GP, GO or GN modifiers, apply CQ and CO for assistant services, and track each Medicare patient against the 2026 KX threshold of $2,480. Plans of care and recertifications are tracked so therapy never runs past an approval.
Therapy-only clinic? See our physical therapy billing services.
Built around the physiatry note
Every Study, Muscle and Unit Captured
Nerve conduction studies, needle EMG add-ons, guidance codes and toxin units are billed from what your physicians document, and checked against payer policy before the claim goes out.
Full revenue cycle
PM&R revenue cycle management services
California Billing Services manages the full PM&R revenue cycle, from the first eligibility check to the final payment. Hand us every step, or only the ones costing you money today.
Insurance eligibility and benefits verification
We verify coverage before every visit and procedure, not just at the first appointment: therapy visit limits, remaining Medicare KX threshold, Medicare Advantage and Medi-Cal plan assignment, and the claim number, adjuster and accepted body parts on workers' comp cases.
Explore servicePrior authorization and referral management
We obtain and track authorizations for epidural injections, facet injections, radiofrequency ablation, chemodenervation, EMG/NCS and therapy, including requests reviewed by vendors such as eviCore and Carelon. For workers' comp, we submit Requests for Authorization supported by MTUS guidelines, and request extensions before an approval runs out.
Explore serviceCharge entry and charge capture
We capture every billable element of a PM&R encounter: each nerve conduction study, the needle EMG add-on, imaging or EMG guidance, botulinum toxin units and documented waste, and each extremity or spinal level treated. Charges are reconciled against your schedule so no procedure goes unbilled.
Explore serviceClaim scrubbing and electronic submission
Every claim is checked against NCCI edits, MUE unit limits, Noridian and commercial coverage policies, laterality and modifier rules before it's submitted. Catching an E/M missing modifier 25 or an EMG add-on billed without its NCS code is far cheaper than appealing a denial.
Payment posting and underpayment recovery
We post ERAs and EOBs and compare every payment with your contracted rates and the California Official Medical Fee Schedule. Underpaid drug lines, partially paid multiple-procedure claims and missed Medicare-to-Medi-Cal crossovers are flagged and recovered, not written off.
Denial management and appeals
We sort every denial by root cause and fix the source. Appeals go out with supporting documentation: Medicare redeterminations through Noridian, Medicare Advantage and commercial appeals, and second and independent bill review for workers' comp.
Explore serviceAccounts receivable follow-up
We work open claims by payer and age, starting with the highest balances. Workers' comp and personal injury claims are tracked separately, including lien balances and case status with attorneys.
Explore serviceCredentialing and payer enrollment
We enroll physiatrists, PAs, NPs and therapists with Medicare through PECOS, Medi-Cal through PAVE, commercial plans through CAQH, and California workers' comp Medical Provider Networks (MPNs).
Explore servicePatient billing and collections
We send clear patient statements, set up payment plans and answer billing calls for your patients. For self-pay services, we prepare Good Faith Estimates under the No Surprises Act.
Reporting and analytics
Every month you get a report on net collection rate, first-pass acceptance, denial rate by service line, days in AR and collections per provider, with EMG, injections, therapy, workers' comp and personal injury shown separately.
Medical coding
PM&R medical coding services
California Billing Services codes PM&R encounters with coders who know physiatry procedures, documentation rules and payer edits. Accurate coding is where clean claims start, and where most PM&R revenue is won or lost.
PM&R-trained coders
Our coders train on PM&R procedures, electrodiagnostic medicine and California workers' comp. They code from the full note, not just the superbill, so every documented service is billed and nothing undocumented is.
Coding audits and documentation review
We audit a sample of your charts against CPT, ICD-10-CM and payer rules, then show your physicians exactly where notes fall short: MDM for E/M levels, muscles and units for chemodenervation, and functional goals for therapy.
ICD-10-CM specificity
We code diagnoses to the highest specificity the note supports, including laterality, the sequelae of stroke and the correct seventh character for injuries. Specific diagnoses meet coverage policies for EMG, injections and therapy far more often.
Common PM&R codes we bill
| Service | CPT or HCPCS codes | What we check before billing |
|---|---|---|
| Office visits | 99202–99205, 99212–99215 | MDM or time supports the level; modifier 25 with same-day procedures |
| Hospital and IRF visits | 99221–99223, 99231–99233 | Medicare billed without consult codes; visit frequency documented |
| Nerve conduction studies | 95907–95913 | Number of studies matches the report |
| Needle EMG with NCS | 95885, 95886, 95887 | Reported only with an NCS code; extremity count matches |
| Needle EMG without NCS | 95860–95864, 95867–95870 | Extremities and muscles documented |
| Chemodenervation | 64612, 64616, 64642–64647 | Site and muscle counts; guidance add-on 95873, 95874 or 76942 |
| Botulinum toxin | J0585, J0586, J0587, J0588 | Units match the vial; JW or JZ modifier |
| Baclofen pump | 62367–62370, 95990, 95991 | Refill and reprogramming documented separately |
| Trigger point and joint injections | 20552–20553, 20600–20611 | Muscle count, joint size and imaging guidance |
| Spine procedures | 62321, 62323, 64490–64495, 64633–64636 | Authorization, levels, laterality and frequency limits |
| Therapy | 97161–97167, 97110, 97112, 97116, 97140, 97530 | GP or GO modifier, 8-minute rule, KX threshold |
California payers
California payer rules we handle every day
National billing companies treat California like any other state. It isn't. Medi-Cal, the California workers' comp system and a heavy Medicare Advantage market each have rules that decide whether a PM&R claim is paid.
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Medicare and Medicare Advantage
We bill traditional Medicare through Noridian (Jurisdiction E) and follow its coverage policies for electrodiagnostic testing and injections. For Medicare Advantage plans, we track prior authorizations under the 2026 federal rules, which require decisions within 72 hours for urgent requests and 7 days for standard ones.
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Medi-Cal and California Children's Services
We bill Medi-Cal managed care plans and fee-for-service Medi-Cal, including Treatment Authorization Requests where required. For pediatric rehab, we coordinate with California Children's Services and its Medical Therapy Program.
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Commercial and Covered California plans
We verify benefits, visit limits and authorization rules for California commercial health plans and Covered California plans before your patient is seen.
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California workers' compensation
We bill under the Official Medical Fee Schedule, submit Requests for Authorization that meet the MTUS, and file PR-2 reports with the bill. We request second bill review within 90 days of an underpaid explanation of review, take disputes to independent bill review, and bill QME and AME med-legal reports under the ML fee schedule.
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Personal injury and liens
We bill personal injury cases on liens and letters of protection, send records and itemized bills to attorneys, and follow every open case to settlement.
Learn moreEHR and systems
PM&R billing inside the EHR you already use
California Billing Services works directly in your EHR, practice management system and clearinghouse. Your physicians keep documenting the way they do now, and nothing has to be migrated. Supported systems are confirmed during scoping.
Physiatry and specialty EHRs
Including the PM&R and orthopedic templates physiatrists use for EMG reports, injection notes and spasticity procedures.
Therapy documentation systems
For practices with in-house PT, OT or speech therapy, we keep therapy charges, plans of care and visit counts in step with physician billing.
Hospital and inpatient rehab systems
For physiatrists rounding in hospitals and IRFs, we capture charges from hospital systems and census reports so no inpatient visit is missed.
Clearinghouses and payer portals
We submit and track claims through your clearinghouse, and use payer portals for Noridian, Medi-Cal and workers' comp carriers to check status, submit documents and work denials.
Step by step
How we take over your PM&R billing
Your billing never stops during the switch.
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Billing review
We review recent claims, denials and payments and show you the biggest revenue gaps.
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Onboarding
We sign a BAA, connect to your EHR and clearinghouse, and confirm every provider is enrolled with every payer.
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Coding and clean claims
Coders review each encounter, and every claim is scrubbed before it's sent.
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Denials and AR follow-up
We work every denial and unpaid claim until it's paid, appealed or closed.
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Monthly reporting
You get a report on collections, denials, days in AR and what we're fixing next.
Compliance and expertise
Accurate, compliant and audit-ready
Good PM&R billing protects you in an audit, not just at payment time.
- Ongoing PM&R and workers' comp coder training.
- Claims checked against current NCCI edits, MUE limits and payer policies.
- Documentation feedback for physicians when a note doesn't support the code.
- HIPAA-compliant systems, role-based access and a signed BAA.
- Billing practices aligned with OIG compliance guidance for physician practices.
Pricing
Simple pricing for PM&R practices
Most practices pay a percentage of collections, so our fee rises only when your collections do. Your rate depends on claim volume, payer mix and the services you need. We'll give you a quote after reviewing your claims.
Claim-level follow-up
Every Service Line Reported Separately
EMG, injections, therapy, workers' comp and personal injury each get their own numbers, so you can see what's working and what we're fixing next.
In-house versus outsourced
In-house billing or a PM&R billing partner?
| In-house billing team | California Billing Services | |
|---|---|---|
| PM&R coding expertise | Depends on who you hire | Coders who work in PM&R daily |
| Workers' comp and Medi-Cal rules | Learned on the job | Built into our workflows |
| Coverage during staff turnover | Billing slows or stops | No gaps |
| Cost | Salaries, benefits, software and training | One percentage of collections |
| Reporting | Varies | Monthly performance reports |
Locations
PM&R billing services across California
California Billing Services provides PM&R billing to physiatry practices throughout California. Our team works remotely in your systems, so practices in every region get the same coders, payer expertise and reporting.
Southern California
Los Angeles, Long Beach, Pasadena, Orange County, Irvine, Anaheim, San Diego, Riverside, San Bernardino, the Inland Empire, Ventura and Santa Barbara.
Northern California and the Bay Area
San Francisco, Oakland, San Jose, Walnut Creek, Santa Rosa, Sacramento and Roseville.
Central California
Fresno, Bakersfield, Modesto, Stockton, Visalia and San Luis Obispo.
Don't see your city? We bill for PM&R practices anywhere in California. See Los Angeles · San Diego · San Francisco · all locations.
Your next step
Find out what your PM&R claims are leaving unpaid
Send us recent claims. We'll show you which denials, underpayments and missed charges are costing your practice and how we'd fix them.
Your information is kept private and never shared.
FAQ
PM&R billing: your questions answered
PM&R billing covers services from physiatrists, who are physicians, while physical therapy billing covers services from licensed therapists. Physiatrists bill E/M visits, EMG and nerve conduction studies, chemodenervation and injections. Therapists bill evaluations and timed treatment codes under a plan of care. Many PM&R practices offer both, so we bill both under one account.
Can't find what you're looking for? Contact our billing specialists