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Physiotherapist Invoice Template

A physiotherapist invoice bills visit, lists services, products and materials on separate lines and states the terms (Due at each visit; insured balances billed once the claim settles). This template is pre-filled for rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation: 8 lines totalling $1,230.00 before tax. Edit it and download the PDF.

Pre-filled for a physiotherapist: rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation. Example prices: replace them with your own.

Document
From (you)
Bill to
Line items
  1. Amount$175.00
  2. Amount$400.00
  3. Amount$225.00
  4. Amount$225.00
  5. Amount$45.00
  6. Amount$45.00
  7. Amount$20.00
  8. Amount$95.00
Discount, tax and payments

Balance due: $1,230.00

Notes, payment details and extra fields
Design, logo, currency and paper
Logo (PNG or JPEG, up to 1 MB; stays on your device)

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From

Granite Physical Therapy Clinic

169 Market Street
Fairview, OR 97024

billing@example.com

(503) 555-0169

Invoice

Invoice #
INV-5551
Invoice date
Oct 29, 2026
Due date
Nov 28, 2026
Terms
Due at each visit; insured balances billed once the claim se
PT license no.
LIC-539041
NPI
See notes
Referring physician and NPI
See notes
Diagnosis code (ICD-10)
See notes

Bill to

Dana Whitfield

52 Aspen Way
Springfield, IL 62704

client@example.com

DescriptionQtyRateAmount
Physical therapy evaluation, moderate complexity (CPT 97162)1 visit$175.00$175.00
Therapeutic exercise (CPT 97110)Range of motion and strengthening10 15 min$40.00$400.00
Manual therapy (CPT 97140)Joint mobilization, soft tissue work5 15 min$45.00$225.00
Neuromuscular re-education, balance training (CPT 97112)5 15 min$45.00$225.00
Kinesiology taping3 each$15.00$45.00
Lace-up ankle brace1 each$45.00$45.00
Resistance band home exercise kit1 each$20.00$20.00
Re-evaluation at discharge (CPT 97164)1 visit$95.00$95.00
Subtotal
$1,230.00
Balance due
$1,230.00

Notes

Thank you for choosing Granite Physical Therapy Clinic. Terms: Due at each visit; insured balances billed once the claim settles.

Payment details

Bank transfer or card. Please quote the invoice number.

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Physiotherapist invoice at a glance

Typical job Rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation
Main billing unit visit
Usual payment terms Due at each visit; insured balances billed once the claim settles
Sample lines 8 lines, $1,230.00 before tax
Largest line Therapeutic exercise (CPT 97110): $400.00 (33%)
Trade-specific fields PT license no., NPI, Referring physician and NPI, Diagnosis code (ICD-10), Date of injury or surgery, Visit no. in plan of care

Sample physiotherapist invoice line items

Rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation: 8 lines adding up to $1,230.00, split into services $1,120.00 (91%), products $65.00 (5%) and materials $45.00 (4%).

Example prices: replace them with your own
ItemQtyRateAmount
Physical therapy evaluation, moderate complexity (CPT 97162)1 visit$175.00$175.00
Therapeutic exercise (CPT 97110) (Range of motion and strengthening)10 15 min$40.00$400.00
Manual therapy (CPT 97140) (Joint mobilization, soft tissue work)5 15 min$45.00$225.00
Neuromuscular re-education, balance training (CPT 97112)5 15 min$45.00$225.00
Kinesiology taping3 each$15.00$45.00
Lace-up ankle brace1 each$45.00$45.00
Resistance band home exercise kit1 each$20.00$20.00
Re-evaluation at discharge (CPT 97164)1 visit$95.00$95.00
Subtotal$1,230.00
Total before tax$1,230.00

What a physiotherapist invoice should include

  • Your physical therapy clinic name, address, phone and email, plus a tax ID if you are registered
  • The customer's name and billing address (Dana Whitfield in the sample)
  • A unique invoice number (INV-5551) and the issue date
  • Payment terms and a due date: Due at each visit; insured balances billed once the claim settles
  • PT license no.: for example LIC-539041
  • NPI: for example See notes
  • Referring physician and NPI: for example See notes
  • Diagnosis code (ICD-10): for example See notes
  • Line items in visit or per item, each with quantity, rate and amount
  • How to pay you: bank details, card link or cheque payee

How physiotherapists bill

Charges per treatment visit, with a longer and dearer first evaluation, while insurers are billed by timed treatment codes in 15-minute units.

Physiotherapists commonly use "Due at each visit; insured balances billed once the claim settles".

U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2024: median hourly wage of Physical Therapists $48.57 (employees, not contractor rates).

Physiotherapist invoicing tips

  • Bill timed treatments in 15-minute units and print the total timed minutes for each visit; under Medicare's 8-minute rule the number of units has to fit the minutes actually spent, and auditors check exactly that.
  • Show the visit number within the plan of care, such as visit 4 of 12, and the referring physician, because many plans cap therapy visits per year and some require the referral on each claim.
  • Braces, tape and bands the patient takes home belong on their own product lines, since plans that pay for treatment often exclude supplies and the patient pays for those directly.
  • For self-pay patients, charge a flat visit fee but still print the CPT codes underneath; it lets them seek reimbursement and makes your price comparable with clinics that bill insurance.

Physiotherapist billing disputes to head off

  • Patients who pass their insurer's visit cap are billed in full for the next visit and feel ambushed. Showing visits used against the authorization on every invoice warns them in time.
  • Merging manual therapy and exercise into one untimed 'treatment' line makes a later insurer review hard to answer; itemizing each code with its minutes leaves a clear trail.

Work a physiotherapist can bill for

Core tasks of Physical Therapists (O*NET 29-1123.00, O*NET 29.x task statements, CC BY 4.0). Each can become a line on the invoice.

  • Plan, prepare, or carry out individually designed programs of physical treatment to maintain, improve, or restore physical functioning, alleviate pain, or prevent physical dysfunction in patients.
  • Perform and document an initial exam, evaluating data to identify problems and determine a diagnosis prior to intervention.
  • Evaluate effects of treatment at various stages and adjust treatments to achieve maximum benefit.
  • Administer manual exercises, massage, or traction to help relieve pain, increase patient strength, or decrease or prevent deformity or crippling.
  • Instruct patient and family in treatment procedures to be continued at home.
  • Confer with the patient, medical practitioners, or appropriate others to plan, implement, or assess the intervention program.

How to make a physiotherapist invoice

  1. Add both parties

    Enter Granite Physical Therapy Clinic (your business) and the customer, Dana Whitfield, then pt license no..

  2. Number and terms

    Give it a unique number such as INV-5551 and set the terms to Due at each visit; insured balances billed once the claim settles.

  3. List the work

    One line per item: the sample runs from "Physical therapy evaluation, moderate complexity (CPT 97162)" (1 visit) to "Re-evaluation at discharge (CPT 97164)" (1 visit).

  4. Check the total

    The 8 lines come to $1,230.00; add sales tax only if your state taxes physical therapy.

  5. Download and send

    Download the PDF or print it, then keep a copy with the physical therapy records.

Frequently asked questions

How do I make a physiotherapist invoice?

Add your physical therapy clinic details, the customer, pt license no., npi, referring physician and npi and diagnosis code (icd-10), then one line per item with quantity and rate. The template above is pre-filled with 8 lines for rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation totalling $1,230.00; change the prices and download the PDF.

How do physiotherapists charge?

Mostly visit. Charges per treatment visit, with a longer and dearer first evaluation, while insurers are billed by timed treatment codes in 15-minute units.

When should a physiotherapist invoice be paid?

Due at each visit; insured balances billed once the claim settles is the usual arrangement. Put the terms and the due date on the invoice so there is no doubt.

How much do physiotherapists earn per hour?

U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2024: median hourly wage of Physical Therapists $48.57 (employees, not contractor rates). Self-employed rates are usually higher because they cover overhead and unbilled time.

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