Specialties
Billing rules change with the specialty
Physical therapy is the first specialty we are building. For each specialty, we write down its billing rules, turn them into checks and test them. We take practices in a specialty only after its checks are tested. Here is where each one stands.
Status
Where each specialty stands
| Specialty | Status | What is different about billing it | Next step |
|---|---|---|---|
| Physical therapy | FIRST SPECIALTYSince 2026-09-29 | Units from treatment minutes, GP on every line, Medicare's KX amount ($2,480 in 2026)1 and certified plans of care. | Read the physical therapy page |
| Occupational therapyExample rules | BY REQUESTSince 2026-09-29 | 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 about your practice |
| Speech-language pathologyExample rules | BY REQUESTSince 2026-09-29 | 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 about your practice |
| Behavioral healthExample rules | BY REQUESTSince 2026-09-29 | 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 about your practice |
| Family and internal medicineExample rules | BY REQUESTSince 2026-09-29 | 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 about your practice |
| PediatricsExample rules | BY REQUESTSince 2026-09-29 | Practices cannot charge for vaccines from the Vaccines for Children program, only fees such as administration.10 | Tell us about your practice |
| ChiropracticExample rules | BY REQUESTSince 2026-09-29 | 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 about your practice |
| PodiatryExample rules | BY REQUESTSince 2026-09-29 | Routine foot care is covered only with qualifying findings, shown with the Q7, Q8 or Q9 modifier.12 | Tell us about your practice |
| DermatologyExample rules | BY REQUESTSince 2026-09-29 | Biopsy codes depend on the technique used.13 | Tell us about your practice |
| Obstetrics and gynecologyExample rules | BY REQUESTSince 2026-09-29 | 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 about your practice |
| Other specialties | BY REQUESTSince 2026-09-29 | Tell us what you bill and who bills it today. | Tell us about your practice |
What the labels mean
| Label | What it means |
|---|---|
| FIRST SPECIALTY | The specialty we are building first. Its billing rules are on its page, with sources. |
| BY REQUEST | Not offered yet. Tell us about your practice. Requests help decide what we build next. |
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 before we take a practice in a new specialty, these things happen.
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. When a check fails, the claim goes to a person on your billing team. Nothing changes a code on its own.
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 take practices in a specialty only after its checks are tested.
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- Charge review and coding checksINCLUDED
- Claim scrubbing and submissionINCLUDED
- Payment postingINCLUDED
- Denials and appealsINCLUDED
- Accounts receivable (A/R) follow-upINCLUDED
- Patient statements and callsINCLUDED
- Month-end reporting (plus dashboard)Month-end reportINCLUDEDClient dashboardPLANNED
- Eligibility and benefitsAUTOMATED CHECK ONLY
- Prior authorizationTRACKING ONLY
- Credentialing and payer enrollmentNOT INCLUDED
Is your specialty not ready yet?
Tell us your specialty, your EMR and how many providers you have. We will say plainly where your specialty stands, and what would have to happen before we could take your practice. Please do not include patient information.
Questions about specialties
Billing rules differ by specialty, and we will not learn them on your claims. 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
Not yet. Both are by request. Tell us about your practice.
Next question: what exactly do you do?
Every part of billing we run, what we check or track, and what stays with your practice.