Revenue code 0420 relates to Physical Therapy Services. Think of it as the hospital or facility telling the insurer, “We gave this patient physical therapy in our department.” For orthopedic patients, PT is a big deal, almost every hip, knee, or spine surgery needs it for recovery. If you skip or misuse this code, the facility risks losing revenue, and patients risk delays in care approval.
What Is Revenue Code 0420?
Revenue code 0420 is the general code for Physical Therapy (PT). It appears on hospital bills, rehab bills, and sometimes outpatient facility claims.
Where revenue code 0360 focused on operating rooms, revenue code 0420 focuses on therapy rooms. It covers PT services like gait training, strength building, mobility work, and other sessions supervised by licensed physical therapists.
For orthopedic patients, PT is often the difference between walking again or staying limited. That’s why insurers watch code 0420 carefully, they know therapy drives recovery, but they also want proof it was needed.
Why Revenue Code 0420 Matters in Orthopedic Billing
Revenue code 0420 can impact orthopedic medical billing. Here is how:
Payment accuracy
Without revenue code 420, the hospital can’t bill for therapy sessions. That’s lost income for services already provided.
Claim acceptance
Payers expect to see code 0420 linked with therapy-related CPT/HCPCS codes. If it’s missing, claims bounce back.
Audit protection
Using revenue 0420 code correctly shows that the hospital billed PT fairly, based on documentation.
Patient care tracking
Facilities can see how many PT sessions orthopedic patients use, which helps with planning staff and resources.
For an orthopedic patient who just had a hip replacement, PT is not optional. It’s the next step. Without billing it correctly, the hospital provides care but may never get paid.
When to Use Revenue Code 0420: Real Scenarios
Revenue code 0420 isn’t just for textbooks—it plays out every day in orthopedic care. To make it clear, here are real-world examples where 0420 must appear on the bill:
Case 1: The New Knee Learns to Walk
Mr. Ahmed just had a total knee replacement. On day one after surgery, the physical therapist arrives. They help him get out of bed, practice balance, and take a few shaky steps with a walker. This isn’t just “practice”, it’s a billable PT service. The hospital links 0420 with CPT 97116 (gait training) to capture the value of that care. Without it, the facility loses reimbursement for an essential part of recovery.
Case 2: The Spine Surgery Recovery
Sara, 34, undergoes a spinal fusion after years of back pain. Post-op, she struggles to sit and move safely. A PT designs a program for gentle strengthening and teaches her safe transfers from bed to chair. Each of these sessions is billed under revenue code 0420 with the correct CPT codes for therapeutic exercise. In this case, the code doesn’t just capture revenue—it documents the road back to Sara’s mobility.
Case 3: The Fracture Rehab
Ali, 19, crashes his motorcycle and ends up with multiple fractures. After surgeons stabilize the bones with plates and screws, the PT team steps in. They teach him to use crutches, shift weight carefully, and rebuild movement over time. Every inpatient PT session is billed with code 0420, showing insurers that therapy was a structured, skilled service—not just casual walking practice.
Case 4: The Shoulder Fix
Mrs. Khan, 55, goes through rotator cuff surgery. At first, her arm is stiff and painful. PT sessions help her restore range of motion, strengthen the shoulder, and slowly return to daily tasks. Each hospital-based PT visit is billed under code 0420. If coded correctly, the hospital gets paid; if missed, hundreds of dollars per session slip away.
What Revenue Code 0420 Does Not Include
Here’s where mistakes happen. 0420 does not cover every therapy service. Common errors include:
- Occupational therapy (those have their own codes, like 0430).
- Speech therapy (0440 covers that).
- Respiratory therapy (0410 is for that).
- Nursing care or patient education that looks like PT but isn’t.
- Home health PT done outside hospital walls.
If billing teams misplace these services under 0420, insurers deny or flag the claim.
Related Revenue Codes to 0420
Revenue code 0420 is the “general PT” bucket. But there are also sub-codes that narrow it down:
- 0421 – Visit Charge (per PT visit)
- 0422 – Hourly Charge (per hour of PT)
- 0423 – Group Therapy (multiple patients at once)
- 0424 – Evaluation/Assessment (when PT first evaluates the patient)
- 0429 – Other PT Services (catch-all)
Knowing when to use these instead of plain 0420 makes billing more accurate and reduces denials.
Fee Schedule and Sample Rates for Revenue Code 0420
Physical therapy services don’t all cost the same. Fee schedules show how much insurers pay. For 0420, the rate depends on:
- Whether it’s a single visit or a long inpatient course.
- If the session was one-on-one or group therapy.
- How many minutes or hours the patient spent.
- The payer contract.
Here’s a sample look (example rates, not actual for all regions):
| Payer | Per Visit (0420) | Per Hour (0422) |
|---|---|---|
| Medicare | $65 – $85 | $120 – $150 |
| Medicaid | $40 – $70 | $90 – $120 |
| Private Insurer A | $100 – $150 | $200 – $250 |
| Workers’ Comp | $120 – $200 | $250 – $300 |
Notice how private and workers’ comp pay more, while Medicaid usually pays the least.
What Can Affect Reimbursement Rates of Revenue code 0420
Reimbursement for physical therapy under revenue code 0420 isn’t fixed. Two hospitals can bill the same service, but one might get double the payment. Here are the big factors that influence how much money a facility actually collects:
Location
A rehab hospital in New York City or Los Angeles will usually get paid more than a rural clinic in Kansas. Insurers adjust payments based on local cost of living and wage indexes. The idea is that keeping a PT on staff in Manhattan costs more than in a small town.
Type of Facility
Inpatient rehab centers and acute care hospitals often get higher reimbursement rates than outpatient therapy departments. Why? Because their overhead costs are higher—more staff, more equipment, and 24/7 availability. Outpatient clinics may get lower rates, even for the same service.
Session Length and Intensity
Insurers don’t pay the same for a quick 20-minute balance check and a 90-minute post-spinal fusion rehab session. The longer and more complex the therapy, the higher the bill under 0420. Proper documentation of time and complexity is critical to capture this.
Documentation Quality
Insurers want proof that therapy isn’t just “going through the motions.” If PT notes don’t show progress—like improved mobility, strength, or independence—payment can drop. Detailed, goal-oriented notes are the backbone of getting full reimbursement.
Payer Contracts
Every insurance company negotiates its own rates. Two hospitals in the same city might bill the same 0420 service, but one gets $80 while another gets $140. It all depends on how strong their contract is with that payer.
Policy Updates
Rules change, and they matter. For example, the CMS August 2025 CMS update requires tighter linking of PT CPT/HCPCS codes with 0420 revenue code. That means hospitals must prove exactly which therapy was done and why. One missed link can trigger denials, even if the service was real.
Payer-Specific Considerations for Revenue Code 0420
Not every payer looks at revenue code 0420 in the same way. Each one has its own quirks, limits, and paperwork demands. A hospital that bills the same PT service to two different insurers might see two very different outcomes. Here’s how the big players treat 0420:
Medicare
Medicare is the strict parent at the table. It allows physical therapy but keeps a close eye on how much and why. For years, Medicare had “therapy caps”—limits on how much PT a patient could get. While the cap has technically been removed, Medicare still demands strong proof of medical necessity.
For example, a patient recovering from a hip replacement must show documented functional progress: walking farther, climbing stairs, or improving balance. If notes don’t prove that, Medicare may stop paying, even mid-treatment. Hospitals must also tie 0420 tightly to the correct CPT/HCPCS codes.
Medicaid
Medicaid is all about state-by-state rules. Some states allow unlimited PT visits for post-surgery patients. Others cap it—like 20 sessions a year—no matter how complex the surgery. In some states, every PT session after a certain number requires prior approval.
Imagine Ali from our fracture case: if he’s on Medicaid in a strict state, his PT might stop after session 20 unless the hospital submits extra paperwork proving he needs more. Billing teams need to know their state’s Medicaid manual inside out to avoid unpaid claims.
Private Insurers
Private insurers often pay more than Medicare or Medicaid, but they don’t make it easy. Many of them require prior authorization after a set number of PT visits. For example, a plan may cover the first 10 sessions freely, but session 11 onward needs an authorization number from the insurer.
If the billing team forgets to request it, claims can be denied retroactively—even after the therapy was done. On the plus side, private insurers often reimburse at higher rates, making the extra paperwork worth the effort.
Workers’ Compensation
Workers’ comp is a different animal. It usually pays higher rates for PT, since therapy is seen as essential for returning employees to the job. But it also comes with heavy oversight. Adjusters often require weekly PT progress notes and proof that every session is directly related to the workplace injury.
Take a factory worker who injured his back lifting equipment. If therapy notes don’t clearly connect every PT activity back to restoring work function, workers’ comp may push back or delay payment. That means coding 0420 correctly and keeping strong documentation isn’t optional—it’s survival.
Conclusion
Revenue code 0420 may look simple, but it carries weight in orthopedic billing. It tells insurers that the patient received physical therapy services in a hospital or rehab setting. Without it, the bill looks incomplete, and payment may never arrive.
- Use 0420 when physical therapy is provided in hospital or rehab.
- Don’t mix it with OT, speech, or respiratory therapy.
- Link it with correct CPT codes and strong PT documentation.
- Watch payer-specific quirks—each one has different rules.
For orthopedic patients, PT is the road back to normal life. For hospitals, revenue code 0420 ensures that road is funded properly. Use it right, and both the patient and the practice move forward.