What drives contribution per physical therapy visit?

Define what one visit includes

A case visit contains 40 minutes of individualized treatment plus 10 minutes for associated records and turnover. Both consume licensed clinician time. The case has no parallel patient supervision, PTA leverage, cancellation fees or retail add-ons. If evaluations or complex cases take longer, price and capacity must use their actual mix; the template is not a treatment recommendation.

The gross insurance charge proxy is separate from allowed and expected realized amounts. Insurance and patient responsibility together must reconcile to the net amount, with contractual write-offs and permanent expected noncollection removed once. Outstanding collectible balances remain receivables, not additional earned revenue. For a real practice, collect de-identified remittance examples by code, contract and service date. CMS therapy rules

Reconcile the visit contribution

Multiply each payer share by its expected net total: the result is $121.75 per completed visit. Deduct $4.00 of supplies, $4.70 of billing expense and $1.31 of card expense to obtain $111.75. This ties to the executed model unit export. The billing fee applies to insured net revenue in the service month; it is not another contractual reduction and does not change the payer receipt schedule.

Fixed clinical payroll is paid even when visits cancel. Dividing a salary by visits can help compare productivity, but it does not make payroll a per-visit variable expense. At low volume, the average salary cost per completion rises. Contribution therefore needs the company cost structure before it becomes profit. The earnings and cash guide shows that step, including depreciation, loan interest and principal.

Protect documentation and owner management time

Two clinicians provide 68 weekly visit hours after management and other duties, normalized across 52 weeks and 12 months. Divide those minutes by 50 per visit to obtain 353.6 slots. Two treatment stations fit simultaneous work by two therapists; equipment cannot create a third therapist-hour. No extra patient is billed during another patient’s reserved one-to-one time.

The mature base schedule fills 95.0% of available slots. Net slot loss is 9.0%, because 12.0% of scheduled slots cancel and 25.0% of those are refilled. The completed fraction is 91.0%, producing 305.7 normalized monthly completions. This is expected activity, not an instruction to book fractional appointments. A weekly calendar must check actual working days, breaks, leave, evaluations and availability.

California direct-access continuation beyond 45 calendar days or 12 visits, whichever comes first, has qualifying plan-of-care approval conditions and required notices. Coverage does not follow automatically from access. Those are intake/continuation gates; the model does not assume every referral can be scheduled indefinitely or paid without verification. California scope and exceptions

Track the operating and collection denominators separately

Track requested, booked, cancelled, refilled, completed, claim-submitted, adjudicated and collected activity separately. Compare completed minutes with available visit minutes, and recognized expected net revenue with received cash by service-month vintage. A high schedule-fill percentage can coexist with low completed capacity or delayed collections. Count patient episodes separately from visits; this model does not forecast unique patients from a visit total.

The EBITDA threshold is 278.1 completed visits per mature year-one month; the annualized cash-after-debt threshold is 297.4. One accounts for operating costs, the other also for scheduled debt. Actual month cash still depends on receivables and policy-renewal timing. These are local case results, not standard industry productivity targets or insurer reimbursement benchmarks.

Use the funding brief to document contracts and the reserve, and keep actual care decisions with licensed clinicians. A capacity test tells you what paid staff can deliver; it does not establish medically appropriate visit frequency or payer authorization.