Patients often ask how much physical therapy costs. Surprisingly, this question doesn’t have a straight forward answer. This can be confusing for even the most savvy healthcare consumer. In this article, we’ll explain the factors that contribute to the cost of a physical therapy visit.
Your health insurance policy is the biggest factor that determines how much your physical therapy visits cost. This is because your plan determines how physical therapy is covered (i.e. deductible, coinsurance, copay, out of pocket maximum). Additionally, each insurance carrier has their own fee schedule. This means that the insurance carrier defines how much they pay for each treatment code we bill.
Physical therapists utilize the American Medical Association’s Current Procedural Terminology (CPT) codes. When we charge, we link treatment codes to diagnosis codes using ICD-10 (International Classification of Disease, Tenth edition). Additionally, we follow the Medicare 8 Minute Rule to determine how many units to bill for each treatment code.
It isn’t important for you to delve into these complex healthcare systems, that’s our job. But, it’s useful to understand that there are many rules that determine how we bill for a physical therapy visit.
What does this have to do with the cost of physical therapy?
Let’s look at an example of two visits that both last 45 minutes.
- 45 minute treatment #1: 20 minutes (1 unit) Manual Therapy; 25 minutes (2 units) Therapeutic Exercise
- 45 minute treatment #2: 15 minutes (1 unit) Manual Therapy; 15 minutes (1 unit) Neuromuscular Reeducation; 15 minutes (1 unit) Therapeutic Exercise
You can spend the same amount of time in the clinic and the codes billed one visit can be different than the next. This affects your final cost since there are different fee schedules for different codes.
In-Network vs. Out-of-Network
Fee schedules and plan coverage can vary if a provider is in-network or out-of-network with your insurance carrier. In-network benefits usually have a lower deductible and co-insurance, or co-pay. Out-of-network providers may bill your insurance if you have out-of-network benefits, or they may offer you an established cash rate.
Recently, many clinics have begun going out-of-network with certain insurers. This decision becomes clear when insurance carriers reimburse below the clinic’s cost of doing business.
Facility vs. Non-Facility
There’s one more factor that determines how much your physical therapy visits cost. Physical therapy offices not owned by a hospital or rehabilitation facility, are classified as non-facility. Hospital-owned clinics or clinics associated with a facility (like a long-term care facility or rehab unit), are classified as facility. Facilities have larger overhead costs that get passed along to you.
How to Get the Best Price for Physical Therapy
In general, you can get the best price for physical therapy by:
- Choosing an in-network provider (check with your insurance)
- Choosing a non-facility provider
- Learning the typical duration of a visit
- Finding out how many visits the average patient takes to get better
How to Get the Best Value out of Physical Therapy
To get the best value out of physical therapy:
- Learn who you’ll be with during the treatment (licensed provider vs. non-licensed personnel)
- Find out how frequently you’ll need to be seen. Sometimes we need to see you more than once a week. But, if you haven’t recently had surgery or don’t have an overly complex case, an effective physical therapist typically only needs to see you once a week.
- Consistently do your home exercise program on your own to save both time and money (and promote healthy habits!).
- Consider this: going to an out-of-network provider isn’t ALWAYS a bad choice. For example: an in-network clinic that sees you 3x/wk for 5 weeks (15 visits), in the gym with an aide for 1.5 hours (6 units), ISN’T the better price OR better value than an out-of-network clinic that sees you 1x/wk for 45 minutes (3 units) and gets you better in 8 weeks (8 visits).
Time in the clinic is precious and should include guidance from your physical therapist. This can include hands-on treatment, movement re-education, prevention tips, lifestyle adjustments, establishing a home exercise program and making sure you’re progressing toward your goals.
What’s the Bottom Line?
It’s important to understand the estimated cost of your visits before you sign up for physical therapy. As a service to you, we check your physical therapy benefits at these times:
- Prior to your first visit
- When your benefit period resets
- If your insurance carrier or plan changes
Once we learn how your plan covers physical therapy, we give you an estimate of what each visit will cost.
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