Who it is for
Private practicedoor Billing companiesdoor Groups and MSOsdoor DME suppliersdoor Channel partnersdoor Renewal aheadpage Fighting a claimpagePhysical Therapist · TX · identity withheld
vs peer median · TX Physical Therapist · target P90
Documented reimbursement opportunity a year, to the P90 target
Real Medicare volume · 15,913 indexed rates · 5 payers · modeled, not guaranteed
−$15.41 per unit · 7% below the peer median
▼ Rate on file $192.51 | Peer median $207.92 | P90 target locked
specialty basis · n 858 · scored 14 Sep 2026 · TiC filings
The live example is unavailable right now. Nothing is estimated in its place. Run any NPI free.
A real practice from the public record, identity withheld. Not yours until you type yours.
Built for practices that bill under their own tax ID.
A real independent practice, scored 531 of 850 from its payers’ own federal filings. Type yours.
Book a call →No account. No card. No PHI.
How a schedule drifts without anyone touching it45 CFR 147.212
The unit
Outpatient therapy runs on fifteen-minute units.
Under the 8-minute rule, treatment time converts into 15-minute billing units, and therapeutic exercise is where most of those units live. In the CMS Part B data, 97110 sits at the top of outpatient therapy volume year after year. A full caseload turns into hundreds of units a month. The unit is small. The volume is not.
The shave
A few dollars under the benchmark never looks like a problem.
A contracted rate slightly below the benchmark trips no alarm. Every remittance reconciles cleanly against the fee schedule your biller loaded, not against what the same payer pays the practice across town for the same unit of the same code. The shortfall is invisible at the claim level and compounds exactly where volume is highest.
The evaluation side behaves the same way. Medicare prices all three PT evaluation tiers, 97161 through 97163, at one identical rate, and re-evaluation 97164 below them. Commercial payers each set their own numbers for those codes, and most owners have never seen them side by side.
The receipts
Since 2022, the payer’s own number is public record.
Federal law requires every major commercial payer to publish machine-readable files of their negotiated rates, refreshed monthly, including the rate attached to your NPI. The catch is size: one payer’s files run from tens of gigabytes to well past a terabyte. Public in name, unreachable in practice. Reddenda parses and indexes those filings so an owner can look up their own number instead of building a data team.
This is the physical therapy version of a story that runs on every specialty. The rate index is national and covers every specialty that bills commercial payers. The same lookup runs on your own top codes the moment you enter your NPI.
The whole family is in the filings
| Code | Type | What the public record says | Source |
|---|---|---|---|
| 97110 | timed | Therapeutic exercise. The volume backbone of outpatient billing, in 15-minute units on nearly every plan of care, which is why a small per-unit gap compounds here first. | CMS Part B volume leader |
| 97140 | timed | Manual therapy. One of the most billed codes in the Part B data, frequently delivered in the same visit as 97110. Two timed codes, two contracted rates, one compounding gap. | CMS Part B utilization |
| 97112 | timed | Neuromuscular re-education. Valued above 97110 on the Medicare fee schedule. A commercial contract that prices it at or below your 97110 rate is a question worth asking in writing. | Medicare PFS relative values |
| 97530 | timed | Therapeutic activities. Also valued above 97110 on the Medicare schedule. The spread between your own timed codes is part of a negotiation picture most practices never see laid out. | Medicare PFS relative values |
| 97161 to 97163 | untimed | Evaluation, three complexity tiers. Medicare pays all three at one identical rate. Commercial payers each set their own three numbers, and they are published in their filings. | Medicare PFS, policy since 2017 |
| 97164 | untimed | Re-evaluation. Priced below an initial evaluation on the Medicare schedule. Commercial rates for re-evaluation vary widely from payer to payer. | Medicare PFS relative values |
MPPR, in force since 2013: Medicare applies a 50% reduction to the practice-expense portion of the second and later timed therapy procedures in a visit, and commercial contracts write their own versions of the same idea. One more reason the per-unit number you assume is rarely the per-unit number you receive.
Indexed today
Honest about fit
Where this lands hardest
Probably not a fit
Firms that do this work sell it at $75,000 to $350,000 an engagement and quote you on a call. Below them there has only ever been a free single lookup. The whole space in between was empty, and it is the space an owner with one tax ID actually lives in.
A 30 minute working session on your own rates. No slides.
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Every price here is published and charged by Stripe at the amount shown. Multi-NPI and portfolio books are scoped on a call, never priced inline.
No account. No card. No PHI.
Every dollar Reddenda shows is a documented reimbursement opportunity built from public federal filings and peer benchmarks: modeled, not guaranteed. What you actually collect depends on payer response, contract terms, documentation and negotiation. Multi-NPI and multi-location work is scoped on the call, never priced inline.