What file does PlainSight need from a PT practice?

A visit or charges export with the date of service, a patient ID, the service and the amount. Payer and provider columns add payer mix and therapist productivity. Leave out names and diagnoses; the analysis doesn't use them.

What is the KX modifier?

A modifier added to Medicare outpatient therapy claims once a patient's therapy amount for the year passes the threshold ($2,480 in 2026). It confirms the services are medically necessary and documented. It is not a hard cap, but claims above the threshold without it are denied.

Is this billing or legal advice?

No. Payer contracts, Medicare rules and state practice acts change; take advice from a billing specialist or a healthcare attorney before you change how you bill.

Is my data safe if I use PlainSight?

Yes. Files are processed entirely in your browser and never uploaded. Optional AI features send only anonymized summary totals, never names or raw rows.

Home › Guides · Handbooks › Physical therapy practices

Physical Therapy Practice KPIs Worth Tracking Every Month

By PlainSight — Insightful Actions · Updated October 2026 · ~6 min read

A physical therapy practice is paid by the visit, and most of its costs are therapists' hours, which are paid whether or not the patient comes. So the business turns on a few things: how many of the visits a patient was prescribed actually happen, what each visit really collects once the payer is done with it, and how full each therapist's day is. These are the numbers to read every month.

Where your numbers live

Your EMR or practice-management system can export visits or charges to CSV or Excel: one row per visit or billed line, with the date of service, the patient (an ID is enough), the service, the payer, and the amount billed and paid. A provider column adds productivity by therapist.

You don't need names or diagnoses for any of this, so leave them out of the export.

The numbers that tell you the schedule is paying

1. Arrived visits per plan of care

What good looks like: close to what was prescribed, and steady from month to month.

Divide the visits patients attended by the visits in their plans of care. Patients who stop halfway rarely say so; they just don't book the next one. Track the drop-off by referral source and by therapist. A pattern usually points to scheduling (no standing appointments) or to patients who never understood why the full plan mattered.

2. Cancellations and no-shows

What good looks like: known by day, time and payer, and falling.

Count late cancellations and no-shows against scheduled visits. A national survey of outpatient physical therapists, published through UNLV, found a mean no-show rate of 10.4%. At a dozen visits a day, 10% is more than one empty slot every day with a therapist still paid for it. Reminders, a written cancellation policy, and booking the next visits before the patient leaves are the usual fixes.

3. Net revenue per visit, by payer

What good looks like: known for every payer, and checked against what the contract says it should pay.

Divide what was actually collected by arrived visits, payer by payer. Billed charges mean little here; the contract rate is what arrives, and underpaid claims are common enough that it pays to compare each payer's average with its fee schedule. Medicare follows the Physician Fee Schedule: CMS's proposed rule for 2027 would cut the conversion factor for most clinicians from $33.4009 to $32.8409, about 1.7%, as a one-year 2.5% increase for 2026 expires.

4. Payer mix and authorizations

What good looks like: no payer large enough to hurt you with one rate change, and no visit delivered without the authorization its plan requires.

The share of visits and of collections by payer: traditional Medicare, each Medicare Advantage plan, each commercial plan, workers' comp, auto, cash. The same visit pays very differently by payer, so a shift in the mix moves your average more than most rate changes. Authorization rules change by plan and by state: UnitedHealthcare began requiring prior authorization for outpatient PT, OT and speech therapy for Medicare Advantage members in Arizona and California on February 1, 2026. Track authorizations by plan.

5. Therapist productivity

What good looks like: visits per therapist per day close to the schedule you designed, without weeks of overtime.

Arrived visits per therapist per day (or units per hour, if you bill timed codes). A therapist well below the others usually has a schedule full of cancellations rather than a slow pace; one well above may be heading for burnout. Therapists have options: the Bureau of Labor Statistics projects employment of physical therapists to grow 11% from 2024 to 2034. Read productivity beside each therapist's cancellation rate.

6. Medicare's KX threshold and targeted review

What good looks like: every Medicare patient's year-to-date therapy amount tracked, with documentation ready before the thresholds.

In 2026 the KX modifier threshold is $2,480 for physical therapy and speech-language pathology combined, and a separate $2,480 for occupational therapy. Above it, claims need the KX modifier to confirm the care is medically necessary and documented, and above $3,000 a patient's claims can be picked for targeted medical review. The proposed threshold for 2027 is $2,540. Track each Medicare patient's year-to-date amount so nobody crosses either line by surprise.

7. Days to collect and first-time denials

What good looks like: most claims paid within a month, and denials worked within days.

Average days from date of service to payment, by payer, and the share of claims denied the first time. A rising denial rate is usually a front-desk problem (eligibility, a missing authorization, a wrong modifier), and every denied claim costs staff time to rework, if it is reworked at all.

Warning signs worth acting on

Plans of care that end early with no discharge note — patients dropping off, and visits you planned on that won't come.
A payer whose average paid rate is below its contract — underpayments that nobody is appealing.
One therapist's cancellations far above the rest — a scheduling pattern, not a slow therapist.
Medicare patients near the KX threshold without updated documentation.
Visits delivered under a plan that requires authorization, without one on file.

Make it a monthly rhythm

Monthly: arrived visits against plans of care, cancellations, net collected per visit by payer, and visits per therapist. Then pick the largest gap, which is usually cancellations or one payer's rate, and work on that one first.

Let PlainSight read your visit export

Upload a visit or charges export and PlainSight breaks revenue down by service, patient and month, shows how concentrated it is and where it moved, and writes the next steps in plain English. Everything runs in your browser — your data never leaves your device.

See it on a live example →

Opening a practice? Read the free handbook for opening a physical therapy practice — the market, the stages ahead, how each kind of work pays, and what to do first. No account needed.

Frequently asked questions

What file does PlainSight need from a PT practice?: A visit or charges export with the date of service, a patient ID, the service and the amount. Payer and provider columns add payer mix and therapist productivity. Leave out names and diagnoses; the analysis doesn't use them.
What is the KX modifier?: A modifier added to Medicare outpatient therapy claims once a patient's therapy amount for the year passes the threshold ($2,480 in 2026). It confirms the services are medically necessary and documented. It is not a hard cap, but claims above the threshold without it are denied.
Is this billing or legal advice?: No. Payer contracts, Medicare rules and state practice acts change; take advice from a billing specialist or a healthcare attorney before you change how you bill.
Is my data safe if I use PlainSight?: Yes. Files are processed entirely in your browser and never uploaded. Optional AI features send only anonymized summary totals, never names or raw rows.

Sources

Centers for Medicare & Medicaid Services, Therapy Services: the 2026 KX modifier thresholds.
LeadingAge, “CY27 Physician Fee Schedule Proposed Rule”: the proposed 2027 threshold and the $3,000 targeted review threshold.
AHA News, “CMS issues CY 2027 physician fee schedule proposed rule”, July 14, 2026, and 4MBC, “What the 2027 Medicare proposed rule means for your PT clinic”: the conversion factor.
James Bokinskie, Payton Johnson and Trevor Mahoney, “Patient No-show for Outpatient Physical Therapy: A National Survey”, University of Nevada, Las Vegas, 2015.
UnitedHealthcare, prior authorization for outpatient therapy in Arizona and California.
U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Physical Therapists.

This guide is general information for practice owners and managers, not billing, legal, or financial advice. Figures described as “typical” or “common” are survey results and rules of thumb, not standards — always read your own numbers in context.