Biological treatment processes give relatively poor pollutant removal efficiencies in cold regions because microbial activity is inhibited at low temperatures. We developed an enhanced physicochemical-biological wastewater treatment process that involves micro-membrane filtration, anaerobic biofilter, and aerobic biofilter to improve the pollutant removal efficiencies that can be achieved under cold conditions. Full-scale experiments using the process were carried out in the northeast of China, at outdoor temperatures of around −30 °C. The average removal efficiencies achieved for chemical oxygen demand, total phosphorus, ammonia nitrogen, and suspended solids were 89.8, 92.9, 94.3, and 95.8%, respectively, using a polyaluminium chloride dosage of 50 mg L−1. We concluded that the process is effective to treat sewage in cold regions.