PPO Fee Schedule Intelligence
Medicare Part B updates quarterly. Commercial carriers revise fee schedules without notice. Most PT practices discover the changes months later — after thousands in lost reimbursement. ClearPhysicalTherapyRates monitors every carrier, every month, and delivers a plain-English briefing to your inbox.
The Intelligence Gap
Physical therapy reimbursement is governed by dozens of overlapping rate schedules, provider manuals, and CPT policy documents — updated on different calendars, published in different places, with no central notification system.
Medicare Part B issues Physician Fee Schedule updates annually in November, with interim adjustments throughout the year. Commercial carriers — UnitedHealth, Aetna, Cigna, BCBS, Humana — update their contracted rates and provider manual policies on independent schedules with minimal advance notice.
The result: most PT practices are operating on outdated rate assumptions. Billing teams charge what they've always charged. Negotiation windows pass undetected. New CPT codes arrive and practices miss months of correct billing.
ClearPhysicalTherapyRates monitors it all, synthesizes it into plain English, and delivers a single monthly briefing — so you spend your time treating patients, not reading carrier bulletins.
Coverage
Federal
Annual PFS updates, interim conversion factor changes, CPT add-on and new code assignments, and CMS policy transmittals affecting PT billing.
UnitedHealth
State-level fee schedule revisions, active care path policy changes, authorization threshold updates, and network tier adjustments.
Aetna
Fee schedule floor adjustments by state and CPT code, clinical policy bulletin updates for PT services, and credentialing requirement changes.
Cigna
Coverage determination changes for PT modalities, active care path requirements, bundling policy changes, and regional rate differentials.
BCBS
State plan rate schedule changes, credentialing window openings, prior authorization updates, and supplemental benefit changes affecting PT.
Humana
RTM and remote monitoring bundle changes, MA plan PT coverage policies, value-based care program updates, and contracted rate revisions.
State Boards
Supervision ratio rule changes, aide delegation policy updates, telehealth PT coverage expansions or restrictions, and licensure renewal impacts on billing.
CPT Codes
AMA CPT code revisions for 97110, 97530, 97140, 97012 and related codes — new code assignments, bundling edits, and RVU valuation updates.
Monthly Digest
Every change synthesized into actionable intelligence — what changed, which CPT codes are affected, what you should do about it, delivered by the 5th of each month.
"The practices that protect their revenue are the ones that see the changes coming — not the ones still reading last year's fee schedule."
Sample Intelligence Report
Not a data dump. Not a link to a carrier bulletin. A synthesized briefing — written for PT practice owners and billing managers, covering only what changed and what it means for your practice.
Each monthly report includes a CPT code rate change summary for your state, carrier policy alerts, regulatory updates from your state PT board, and a recommended action checklist. Multi-Location subscribers receive a consolidated view across all practice locations.
Medicare Part B — CPT Rate Summary
| CPT | Description | Change | New Rate |
|---|---|---|---|
| 97110 | Therapeutic Exercise | ▼ −3.1% | $30.82 |
| 97530 | Therapeutic Activities | ▼ −2.8% | $31.44 |
| 97140 | Manual Therapy | — 0.0% | $28.16 |
| 97012 | Mechanical Traction | ▲ +1.2% | $14.78 |
Carrier Alert — Aetna
Action Required: Aetna revised its clinical policy bulletin for 97530 effective May 1, 2026 — services now require documented functional limitation in the same note as the treatment. Retroactive audits possible. Update your documentation template before next billing cycle.
We caught a UnitedHealth fee schedule revision that would have cost us about $1,400 a month. Our biller had no idea it had changed. This paid for itself in the first week.
PT Practice Owner · Columbus, Ohio · Practice Monitor Subscriber
Built for PT Practices
Most billing intelligence tools are built for large health systems with dedicated compliance staff. ClearPhysicalTherapyRates is built for the independent PT practice and small group — the practice owner who does the clinical work and reads the EOBs, the billing manager who juggles authorizations and fee schedules at the same time.
We monitor the exact carriers your patients use, track the CPT codes your practice bills most, and filter out everything else. No information overload. No generic alerts. Just the changes that affect your bottom line, in plain English.
Cancel anytime. No contracts. The first digest arrives within 30 days of subscribing.
Subscription Plans
Practice Monitor
Single-location PT practice.
Multi-Location
Group practices & PT networks.
Frequently Asked Questions
How is this different from reading CMS bulletins myself?
CMS bulletins are dense, technical, and published across multiple sites. We read them, cross-reference carrier-specific changes in the same billing period, translate them into plain English, and tell you what to do. It's the difference between reading raw data and receiving an intelligence brief.
Which CPT codes do you track?
Our core coverage includes 97110 (therapeutic exercise), 97530 (therapeutic activities), 97140 (manual therapy), and 97012 (mechanical traction), plus adjacent evaluation codes, functional testing codes, and RTM bundle codes — all major PT billing categories.
Do you cover all states?
Yes. You select your state at signup, and we monitor your state PT board in addition to federal Medicare PFS changes and national carrier rate updates. Multi-Location subscribers can specify multiple states.
When does the first report arrive?
Within 24 hours of subscribing you'll receive a welcome email confirming your coverage. Your first full monthly digest arrives by the 5th of the following month (3rd for Multi-Location subscribers).
Can I cancel at any time?
Yes. No contracts, no cancellation fees. Cancel anytime from your Stripe billing portal and you'll retain access through the end of the billing period.
Is this a legal or compliance service?
ClearPhysicalTherapyRates provides fee schedule intelligence and monitoring — not legal advice or formal compliance certification. For legal interpretation of regulatory requirements, consult a healthcare attorney. We help you stay informed; your compliance team acts on that information.
Subscribe
Fee schedules change every quarter. Provider manuals update without announcement. CPT codes get repriced without a press release. Subscribe to ClearPhysicalTherapyRates and know within 30 days of any change that affects your reimbursement.
No contracts · Cancel anytime · First digest within 30 days