PT software built around the cash visit
A cash-based PT visit is an appointment, a note and a card payment. Most PT platforms wrap that sequence in claim-shaped workflow, because insurance billing is what they were built for, and a cash practice ends up clicking through steps it does not need.
In MegAligna the cash visit is the default path. A hybrid practice still seeing insurance patients gets superbills and biller exports from the same chart rather than running a second system alongside.
From evaluation to card payment
- Included
Evaluations and daily notes
Initial evaluation, daily note and re-evaluation templates built from your own fields, with a signed-and-locked lifecycle. Each note is pre-filled from that visit's captured data; last week's objective measures do not copy forward yet.
- Included
Plans of care with visit tracking
Planned frequency and duration against actual attendance, with drop-off visible per patient before it becomes a self-discharge.
- Included
Units drafted from delivered minutes
The visit's delivered minutes become units by the unit length and rounding you set per payer: round down, round to nearest, or fractional. Neither Medicare's pooled 8-minute rule nor the AMA per-code rule is modelled, and each booked visit carries one code, so a visit mixing timed codes needs its units set by your biller.
- Included
Card payments and balances
Per-visit card payment and patient balances for the cash side, and per-session exports for the out-of-network side. Prepaid visit packages are not built, and the superbill and CMS-1500 documents themselves are gated on AMA CPT licensing.
- Not included · v2
In-network Medicare claims workflow
Not offered. Claims are not submitted from here, and Medicare-specific billing compliance, threshold tracking and plan-of-care certification workflow, is not carried. In-network-heavy clinics need a platform built for that work.
The 8-minute rule, the KX threshold and the certification clock
Three Medicare mechanics decide whether an in-network PT visit is paid, and a cash-based practice should know exactly which of them this software carries.
The 8-minute rule. Timed-unit errors are the most common billing leak in PT. One minute decides a unit at the 22-and-23-minute boundary, and Medicare’s pooled rule and the AMA per-code rule can produce different unit counts on the same visit. Here, units are drafted from the visit’s delivered minutes under a per-payer rounding setting; the pooled Medicare calculation across several timed codes is not modelled. The 8-minute rule calculator runs both rules side by side for a visit you want to check by hand, and the 8-minute rule explained covers the arithmetic itself.
The KX threshold. For 2026, once a patient’s PT and speech therapy together pass $2,480 in the year, Medicare denies further claims unless the KX modifier attests that the care is still medically necessary. The software does not count a patient’s spend against that threshold or append KX.
Plan-of-care certification. Medicare outpatient therapy runs under a plan of care that a physician or qualifying practitioner certifies, and recertifies at least every 90 days. Plans of care and visit tracking are here; the certification and recertification workflow is not, which is a large part of why in-network Medicare clinics are pointed elsewhere.
The rest of the billing surface (modifiers, superbills for the out-of-network side, and what your biller actually receives) is covered in physical therapy billing software.
Common questions
Does it apply Medicare's 8-minute rule automatically?
Does it track the KX threshold or plan-of-care recertification?
What about Medicare patients at a cash practice?
Document a test evaluation and daily note
14 days, no card required. Use made-up patients while you evaluate: real patient information waits until a business associate agreement is in place.
Sources
- CMS Therapy Services: CY 2026 KX modifier threshold of $2,480 for PT and SLP combined, and claims above it without KX are denied (checked October 14, 2026)
- 42 CFR 424.24(c): outpatient therapy plans of care must be certified by a physician or qualifying practitioner and recertified at least every 90 days (checked October 14, 2026)