Physical Therapy Clinic Acquisition & SBA Underwriting Model — Payer Mix, PTA/CQ Differential, DSCR

Description
The seller's pro-forma prices a margin plan the payer mix won't let you run. It shows $693,650 on the seller's pro-forma against $508,501 on the cash flow a bank will actually finance. The pro-forma is built on two improvements the seller never made: converting visits from PT to PTA delivery, and recovering slots lost to no-shows. The first improvement, on a Medicare-heavy book, is worth almost nothing. Medicare pays 85% for services furnished in whole or in part by a physical therapist assistant (the CQ modifier, in force since 1/1/2022), and that haircut eats nearly the entire labor-cost saving. On a commercial visit the same management decision saves $11.88; on a Medicare visit it nets $0.20. Which one you get is decided by the payer mix, not by effort. This model underwrites an outpatient physical therapy clinic purchase. It builds net revenue from visit volume and a payer-mix allowed rate per visit, applies the PT/PTA delivery-mix and the CQ differential, derives SDE and Adjusted EBITDA, and runs an SBA 7(a) stack with a DSCR gate. It shows DSCR true (1.48x) against the naive DSCR (3.28x); at the pro-forma price DSCR falls to 1.14x, failing both the 1.25x lender convention and the 1.15x SBA floor. A dated, published down-case (five consecutive years of Medicare conversion-factor cuts, 2027 proposed -1.68%) drives it to 0.84x. Three payer-mix profiles, break-even visits per day, and the overpay avoided ($185,148). Excel and Google Sheets compatible, no macros: 157 QA checks across three engines, two logic proofs, no IRR. Full PDF guide and README included. Educational planning tool, not financial, legal or medical advice.