Let’s call it what it is: every denied claim is money you earned but didn’t get paid for.
You provided the treatment. You billed the right codes. And still, the claim came back denied—again.
At PT Billing, we deal with this every single day. And we know what most clinics don’t: a well-written, efficient appeal letter can turn a denial into a payment—fast.
This article is your straight-up guide to submitting efficient appeal letters for denied physical therapy claims that actually work.
Why Physical Therapy Claims Get Denied
Before you even draft an appeal, you need to understand why the claim was denied. Most denials fall into one of these buckets:
- Missing documentation (like evals, notes, or plan of care)
- Wrong or mismatched codes
- Medical necessity not proven
- No authorization
- Late filing
- System or payer error
The appeal needs to respond directly to that denial reason. Nothing more, nothing less.
Step 1: Read the Denial Carefully
Start with the Explanation of Benefits (EOB). Look at the denial reason code and the description. Know exactly what the insurance company says is wrong.
Pro tip: Don’t guess. Payer-specific denial codes are available online. Know what the hell they actually mean.
Step 2: Get Your Backup Ready
You cannot submit a good appeal without proper documentation. Here’s what you need for most PT claims:
- Initial evaluation
- Plan of care
- Daily notes / progress notes
- Authorization records
- Billing sheet with CPT + ICD-10 codes
- Referral (if applicable)
Put it all together in one file. Clear, clean, complete.
Step 3: Write the Damn Letter (Efficiently)
Here’s what a legit appeal letter should look like. No fluff. No emotion. Just facts, formatting, and a polite demand to pay up.
[Your Clinic Letterhead]
[Date]
To:
[Insurance Company Name]
[Claims Appeals Dept]
[City, State ZIP]
RE: Appeal for Denied Claim
Patient Name: [Insert Name]
Date of Service: [Insert Date]
Policy #: [Insert ID]
Claim #: [Insert Claim #]
To Whom It May Concern,
We are appealing the denial of Claim #[Claim #] for physical therapy services provided on [Date] at [Clinic Name]. The stated denial reason is “[Insert Reason]”.
Attached are the supporting documents:
- Initial evaluation
- Plan of care
- Daily notes
- Authorization
- Coding references
These services were medically necessary and billed according to the patient’s plan benefits. Please reprocess this claim and issue payment accordingly.
Thank you,
[Billing Contact Name]
[Your Title]
[Your Phone + Email]
[Clinic Name]
Step 4: Submit According to Payer Rules
This is where most appeals fail. Every payer has their own rules. Follow them. Period.
- Mail or fax? Know which one.
- Specific forms required? Use them.
- Deadline to appeal? Usually 30–60 days. Don’t miss it.
- Online portal? Upload in the right spot with correct claim number.
Don’t assume. Look it up—or let us do it for you.
Step 5: Follow Up. Then Follow Up Again.
Call 15–20 business days after submission. Ask:
- Has the appeal been received?
- Is it under review?
- Is anything missing?
Document the call. Get a name. Get a reference number. If they say it was never received? Send it again—this time with proof.
Want to Stop Doing This Every Week? Here’s the Real Fix.
At PT Billing, we don’t just wait for denials—we prevent them. And when they do happen, we handle the appeal the right way: fast, documented, and payer-specific.
We know what insurance companies look for. We know how to speak their language. We get our clinics paid.
If your team is overwhelmed with appeals, underpaid on claims, or just tired of going in circles—hand it off to us.
You Do the Care. We Get You Paid.
Stop wasting time writing appeals by hand, Googling payer rules, or waiting on hold for 45 minutes just to get stonewalled.
PT Billing specializes in one thing: getting physical therapy clinics paid.
We write appeals that work, file them fast, and follow up like your revenue depends on it—because it does.
Book a consultation with PT Billing now, and let’s fix your revenue cycle for good.