PM&R Billing Services

Physical medicine and rehabilitation, or PM&R, covers a wide range of care: stroke and spinal cord recovery, chronic pain, nerve testing, and spasticity treatment. Practices may bill office visits, electrodiagnostic tests, drug injections, and in some cases therapy services, all from one location.

This breadth creates real billing risk. Nerve testing codes depend on counts of studies, toxin injections need drug and procedure codes together, and therapy codes are time-based. Westmont Revenue Partners connects PM&R practices with vetted billing experts who know how these pieces fit and how payers review them.

Who this is for

• Physiatrists in private practice or hospital-based groups
• Inpatient rehabilitation physician groups
• Outpatient rehab clinics with physician oversight
• Practices that offer EMG and nerve conduction testing
• Nurse practitioners and physician assistants in rehab medicine

What gets billed

• New and established patient visits
• Nerve conduction studies
• Needle electromyography
• Botulinum toxin injections for spasticity
• Joint and soft tissue injections
• Therapeutic exercise and activity sessions
• Physical therapy evaluations
• Inpatient rehabilitation physician visits
• Durable equipment and brace orders
• Care plan oversight and team conferences

Commonly billed codes

Code	Type	What it covers
99214	CPT	Established patient visit of moderate complexity
95907	CPT	Nerve conduction studies, one to two studies
95885	CPT	Needle EMG add-on for a limb, with related nerve conduction tests
64642	CPT	Chemodenervation injection of one arm or leg, one to four muscles
J0585	HCPCS	OnabotulinumtoxinA drug, billed per unit
97110	CPT	Therapeutic exercise, billed in 15-minute units
97112	CPT	Neuromuscular re-education, billed in 15-minute units
97530	CPT	Therapeutic activities, billed in 15-minute units
97161	CPT	Physical therapy evaluation of low complexity

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in PM&R

Counting nerve studies. Payers pay for nerve conduction codes by the number of studies done. Billers check the report against the code range so the count is accurate.

Linking EMG and nerve studies. Needle EMG codes are based on limbs and combined with nerve testing. Billers confirm the pairing follows current coding guidance.

Toxin drug and injection billing. A toxin claim has a drug code with units and a procedure code for the injection. Billers record units used and wasted, and match them to a diagnosis the payer accepts.

Prior authorization for drugs and testing. Some plans require approval for toxin or for certain studies. Billers gather the clinical details early so treatment is not delayed.

Therapy time and supervision. Time-based therapy needs minutes recorded for each service. Billers confirm that minutes match units and that the right provider type is listed.

Inpatient rehab rules. Physicians who work in inpatient rehabilitation facilities follow facility-linked rules and documentation of medical need. Billers track visit levels and reporting.

Equipment orders. Braces and mobility devices need clear documentation of need. Billers work with suppliers to avoid claim gaps.

How Westmont can help

• We match your practice with vetted billing experts who have experience in PM&R, electrodiagnostics, and therapy billing.
• Matched experts can support end-to-end revenue cycle management, from verification to payment posting.
• Denial management support covers test counts, toxin units, and therapy time rejections.
• Credentialing and payer enrollment help is available for new physiatrists and clinic sites.

Frequently asked questions

How is EMG and nerve conduction billed?

Billers report nerve conduction by the number of studies and add needle EMG by limb when performed. The report must show what was tested. Payers watch for overuse, so keep records clear. Check current coding guidance and payer policy before billing.

How do you bill botulinum toxin injections?

The claim typically includes a drug code for the product and units, plus a procedure code for the injection. Units wasted may be reportable under certain payer rules. A diagnosis that supports medical need is required. Check payer policy first.

Can PM&R bill for physical therapy?

Yes, when therapy is delivered by qualified staff and the practice is set up to bill it correctly. Time-based codes need documented minutes. Medicare has rules about who can supervise and bill. A PM&R billing company can help build compliant workflows.

What is the difference between PM&R and physical therapy billing?

PM&R physicians bill for evaluation, procedures, and testing, while therapists bill for treatment sessions. Some practices do both. The coding, credentials, and documentation rules differ for each, so separate workflows are needed.

Why do rehab claims get denied?

Common reasons are lack of prior approval, missing minutes, test counts that exceed policy, and unsupported diagnoses. A billing partner can track denial trends and fix the cause at the front end.

Related billing services

• Pain Management
• Physical Therapy
• Occupational Therapy
• Neurology
• Neurodiagnostics (EEG, EMG)