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Appeals for physical therapy practices, built from your chart.

Therapy denials usually turn on the plan of care, its physician certification and measurable progress. Matches each payer rule to the evaluation, signed plan of care, progress reports and outcome scores in the chart, and flags a missing certification before the letter goes out.

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A physical therapist guiding a patient through a stretching exercise on a treatment table

What the reviewer looks for.

These are the points a physical therapy appeal has to prove. ClaimDoc checks each one against your record and names the page that proves it, or the document that is missing.

  1. Evaluation with objective findings

    An evaluation documents the diagnosis, objective measures and functional limitations that therapy addresses.

  2. Written plan of care with measurable goals

    A written plan of care states measurable goals and the type, frequency and duration of treatment.

  3. Services needed a licensed therapist

    The treatment notes show services that required the skills of a licensed therapist.

  4. Measurable progresswhen it applies

    Re-measurement shows objective progress toward the goals, or skilled care needed to maintain function.

The records it asks for.

ClaimDoc asks only for what this denial needs, marks what you've uploaded, and says in a line why each one matters.

  • Initial evaluationneededBaseline objective measures and functional limits are the foundation of a necessity argument.
  • Plan of care with the physician's or NPP's signature and dateneededA signed, dated plan of care covering the denied dates is the most common reason therapy appeals win or fail.
  • Daily treatment notes for the denied datesneededProve what was done on each denied date, by whom, and for how long.
  • Progress reportsShow measurable progress toward goals, or why skilled care is needed to maintain function.
  • Outcome measure scores (LEFS, ODI, NDI, PSFS, gait speed)Standardized scores make progress objective rather than a matter of opinion.

Denials it handles.

Plain words first. For each, what usually decides the appeal.

  • “Not medically necessary”

    A signed, dated plan of care, objective baseline and re-measurement, and why the care needs a therapist.

  • “Over the yearly therapy limit”

    Medicare: the KX modifier with documentation that the therapy is still medically necessary.

  • “Visit limit reached”

    The plan's own exception path, or a necessity argument where one exists.

The rules ClaimDoc holds for physical therapy.

Stored word for word

Medicare coverage on file

4 local and national coverage documents from CMS, across 2 Medicare contractors. When a Medicare denial rests on one, the letter names the one for your contractor and asks which provisions applied.

Payers, by how much is known

  • AetnaTested end to end
  • Cigna HealthcareTested end to end
  • HumanaTested end to end
  • Original Medicare (Part A outpatient and Part B)Tested end to end
  • UnitedHealthcareTested end to end
  • Aetna Medicare AdvantagePolicy sources on file
  • Alignment HealthcarePolicy sources on file
  • Cigna Medicare AdvantagePolicy sources on file
  • Clover HealthPolicy sources on file
  • Devoted HealthPolicy sources on file
  • SCAN Health PlanPolicy sources on file

Search every payer

Tested, not promised.

Each of these ran from upload to a finished, verified packet on synthetic records, and every factual sentence traced to a page of the record or a stored policy.

  • Original Medicare (Part A outpatient and Part B)Medical necessity appeal built on Medicare's form; 25 of 25 sentences sourced2026-11-12
  • Original Medicare (Part A outpatient and Part B)KX threshold redetermination built; 30 of 30 sentences sourced2026-11-12
  • Original Medicare (Part A outpatient and Part B)Stopped and named the unsigned plan of care2026-11-12
  • HumanaMedicare Advantage appeal with signed waiver of liability; 26 of 26 sourced2026-11-12
  • AetnaAppeal against Aetna's own policy from a scanned evaluation; 33 of 33 sourced2026-11-12
  • AetnaPlanted instructions in a note never reached the letter; 21 of 21 sourced2026-11-12
  • Cigna HealthcarePrior authorization appeal on Cigna's form; 12 of 12 sourced2026-11-12
  • UnitedHealthcareRouted to a corrected claim instead of an appeal2026-11-12

Fictional patients and clinics. A passing run shows the system behaved correctly on that kind of case, not that a payer will overturn a denial.

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