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So How Much Did My Physical Therapy Cost?

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I still haven’t received my bill from my physical therapist yet for my knee problem. But, I did get my explanation of benefits from my insurance provider so I know how much my bill is going to be. I cannot believe how much it cost!

$222/visit

The first visit I had, I can understand that cost and I’m okay with that cost. My condition was evaluated and that was some real one-on-one time. The second visit, well, it was cut short for one so it was less than an hour (50 minutes). Then I spent 10 minutes on an exercise bike while the trainer sat and pedaled next to me. Then I was given an ultrasound treatment (which did feel nice for a few hours after the visit) and the trainer taped me knee (only to have it unravel by the time I went to bed). The last five minutes were spent reviewing my homework exercises. To me, it wasn’t worth the continued visits since the trainer said they would be the exact same thing.

After my insurance, each visit cost almost $65. Let’s say that I stuck with the program for the rest of the five weeks at two visits/week. That would have been $650. I knew I had to fess up to my doctor since I saw her again a little bit ago. Her response? She asked if I received some exercises to do. I told her that I did and I have been doing them and I am also trying to be more active overall. I also said I was concerned about the cost. She understood and gave one of those smiles like, “Yeah, I know they are pretty ex-pen-sive!” but she couldn’t say that LOL. But she approved.

A few changes have made a huge difference. My weekends are basically pain free now. During the week is a different story, though, since I still sit for long periods and it hurts my knees. Inactivity has taken a toll on my body and it is going to take some time to reverse it but it can be done. I am making progress, though 🙂

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99 Comments

  • Reply Mark |

    I’ve seen a lot of comments and would like to shed some light on the topic since we operate a private practice physical therapy clinic.

    The insurance companies continue to raise rates and thus many people have a $60 copay. BUT, the practice agrees to certain contract rates which mea we make dramatically less than you think we do. Our rate need to be higher than the insurance because most contracts reimburse us the LESSER of our rates or the contract rate.

    For instance, if I charge $50 for an evaluation 97001 and it takes 1 hour, and the contract to perform a 97001 is $70, the insurance will pay us $50. That $50 means the patient pays us $50 copay instead of $60 and the insurance company pays $0!

    So, we providers charge $100 and the patient pays a $60 copay (for example) and the insurance pays $10.

    Either way, it is not the provider making big bucks (at least we don’t) it’s we take a hit, you take a hit, and the insurance company saves on both ends. After all, pull their annual report and see what the profits are.

    What do we do to help our patients? We encourage patients to go to a High Deductible Health Plan for catastrophic use only. Just because you have insurance doesn’t mean you have to use it, right?

    We encourage people to self pay. We currently charge $69 for return visits, see patients for 45 minutes on average and they work directly with a Doctor of Physical Therapy. Honestly, there is not a lot of profit in it, but I sleep well at night and make a living.

    Thanks!
    Mark

    • Reply arnie |

      i used to own a private physical therapy practice 2005-2010. and, i can tell you FOR SURE that Mark’s account of insurance reimbursement is very much not true in my view. if you aren’t making very much money Mark, you must be brain dead or just not seeing more than 2 patient’s a day.
      i can tell you that while i was working and billing insurance, some paid the full treatment price of close to $230/hour. yes, PT’s (and other health care prof that bill insurance) do over-charge just to see what the idiot insurance company will reimburse us for. it’s full-on highway robbery. i am not capable of ‘walking on water’, but i did give solid one on one treatments. they certainly were not ‘worth’ $230/hour. i wouldn’t pay it.
      I do, unequivocally, agree with Mark on the ‘just pay cash’ it benefits EVERYONE including the patient who pays less for a lighter weight insurance plan and less headaches for the practitioner.

      • Reply David |

        I agree with Mark. Things are much different now than they were even a few years ago. I am a PT who owns his own practice and we are now accepting $40/session from cash payors since the insurances are paying so little and they have been raising the co-pays that the patient is responsible for. By charging a low cash price, the patient can continue coming to their visits, we make a little less than a typical insurance paid visit, but we avoid the insurance company’s games and red tape. BTW we are one of the largest providers of outpatient PT services in our city and our overall average visit rate paid to us through insurances came out to $56/visit….after waiting sometimes 6 months for payment. On top of that, we pay 5.5% to our billing company to help us navigate all the insurance BS that continually changes. So in reality we receive an average of $52.92/visit for insurance paid visits. We typically don’t collect on co-pays or else we would not be in business for long. Patients have a hard enough time paying for premiums, let alone $50-60 co-pays.

    • Reply Terri |

      Sorry, don’t buy it. I was a month into getting my first EOB and was charged $455 for 12 on a tens machine and then $752 for exercises that consisted of shoulder and neck shrugs I could not even do yet and there was nothing I was even assisted with. That was only the beginning. I wonder if the insurance companies even know what is going on here?

  • Reply Maureen |

    Check out the Health Care Blue Book online.
    It will give you fair prices for cpt codes based on where you live.

    I was charged $435 for a PT appt at Group Health Cooperative in Seattle, recently. I just filed a complaint with the insurance
    commissioner.

  • Reply Justine Bernard |

    I’m shocked by what clinics in this blog are charging. We charge $120 for initial visits and follow up visits. These sessions are 55 min one on one with a licensed Physical therapist. If you see a PT aide (all our aides have min of 10 years experience in therapeutic exercise) the sessions are $90. $400 is outrageous!!!

  • Reply Kurt |

    My wife went to 5 sessions, 45 minutes each, of physical therapy. When we got the bill it was for $1,600, minus $100 adjustment per their contract with the insurance company. So that comes to $300 per session. We were a little shocked. So far they don’t seem willing to give any kind of price break, even though we have to pay that out of pocket (our insurance has a $3,000 deductible.) Wish we’d have known the price before-hand. We would have said no thanks.

  • Reply Cricket |

    I am a PT who is tired of the games insurance play. How is it fair that copay made by pt is $60 per visit while insurance companies take my hundreds of dollars for insurance coverage and they are able to pay 1/6 the bill. The insurance touts that it 80/20 coverage, but that is not truthful. More like 5% paid by insurance, 40% by patient, 55% written off by therapist. I want to start a cash only PT practice, charging $30 per visit.

      • Reply David |

        I have a question. I am a PT who is trying to build my cash payment client caseload. I have a huge problem with Medicare patients because supposedly it is illegal to accept cash payments from Medicare patients even if they want to pay it, and I am not a provider with Medicare. That seems illogical to me. Also Medicare does not allow any PT Techs to assist with treatments or for me to treat multiple patients at the same time. So when we have a Medicare patient in the clinic, it basically calls for us to not schedule any other patients during that hour, even though we typically do 30-45 min exercise programs with everyone and they are utilizing different machines or exercise stations. If I am only able to generate $40-50/hour with one Medicare patient per hour, then it does not even pay for the therapist labor cost which is more than that because of the dire shortage of PT’s in my city, let alone the cost of running the office and paying support staff.

        • Reply KL |

          It is not illegal to accept cash payments from Medicare patients. From the APTA website:
          “If the patient does not qualify for an exception to the therapy cap in 2013, what are my options for delivery of services to my Medicare patients who exceed the cap amount?
          If the patient does not qualify for an exception to the therapy cap, Medicare beneficiaries can continue to receive services and pay for these services out of pocket.
          If the patient elects to pay out of pocket, the provider must obtain a signed Advanced Beneficiary Notice (CMS-R-131) (ABN) from the patient. Then the therapist can collect cash from the beneficiary or bill the patient’s secondary insurance. The secondary insurance may require a denial from the Medicare program before it will cover these services.”
          http://www.apta.org/Medicare/TherapyCap/FAQ/

  • Reply nina |

    After reading these comments, I am glad I don’t have health insurance at all, in spite of the tongue lashing I get from everyone. I will pay for it all out of my own pocket, emergenices included. Insurances companies are evil.

  • Reply David |

    I had surgery ACL surgery 10/30/12. I have been up front with the people at PT about not having insurance and that I’m paying out of pocket, you can imagine my shock to find out I have been billed $342 a session! Non of my sessions have been over an hour and the only equipment that I’ve used is an exercise bike and rubber bands. I am sickened by this and I am seriously considering discontinuing PT. Furthermore some research that I’ve done shows people far ahead of where I am at this point 5 weeks post op. I’m not sure what the point of my rant is other than make sure you keep in close contact with the people who bill you! Livid in Maine

  • Reply Maureen |

    Hi Justine,

    $120 per initial session is what the Health Care Blue Book
    suggests. Your clinic has pricing integrity.

    Not Group Health Collective in Seattle. I’m paying monthly payments to pay off the $435 I was charged by Phyllis Collins, PT.
    When I approached Phyllis about the bill– I was sure it was a mistake– she told me she had no control over cost.

    I filed a complaint with the Insurance Commissioner– they tried to address it but GHC’s representative said that they had no control over the cost that a provider submits.

    No accountability all around.

  • Reply Kelly |

    I just had 5 physical therapy appointments for a back injury that consisted of warm-up on stationary bike, stretching and heat … and the charges ranged from $400 – $700 per session. $700!!! I have a $1000 deductible + 10% coinsurance so have a bill of $1200+ sitting in front of me. I am fighting the charges now but not sure I’m going to have any luck.

    And like many of you, if I had known, I wouldn’t have gone to 1 appointment!

  • Reply Sandy |

    I went to ATI in Carol Stream IL. Was there for 45 sessions,did stationary bike,and bands,and walking on lines. For foot. Got the bill and was charged $400. My insurance pays 80%. So going 3 times aweek as dr ordered,comes out i pay $960 a month. I was in shock when i seen what i owed. Office girl said insuranced approved and i only pay 20%. She also stated if i pay more then $20 a visit let her know,something is wrong. So went back to her said why so much. She says she cant control what the therapist charges. Such a rip off. And really all they did to me i could of took one session and learned to do all at home for FREE.

    • Reply Maggie |

      Sandy,
      Physical therapy has rapidly changed over the past 5-10 years. Gone are the days where any of my patients attend 3x/wk because it is almost never medically necessary. As a clinician, my first responsibility is to empower the patient to self-manage as optimally as possibly through self manual techniques and corrective/enhancement exercises. Once the patient understands that getting better is a course of action driven by them, 50% of my clients make the effort and do the work. I typically see my patients 1x/wk or down to 1x/month. I have an ethical/moral obligation to treat smarter-not longer or more expensive with high prices and low-evidence modalities. My average non post-op patient participates in 9 sessions, with my range from 2-30.

      Unfortunately, some PT companies set unreal expectations regarding billing practices that are not consistent with ethical standards. I have left 4 such companies (in the course of 10 years) for this reason.

  • Reply Sandy |

    Ment to say 45 minute seesions not 45 sessions. Trust me after bill came for 4 i learned my lesson fast to quit lol

  • Reply Ann |

    In our office private pay for an evaluation. is $75 and followup visits are $50. This is in upstate NY. NYS workers comp and nofault reimburse $83.32 for an evaluation and $49.60 for each followup. MVP insurance pays $47 for an evaluate and $42 for followup if you have no copay. CDPHP pays $52.50 for followup if you have no copay. If you have a $50 copay per your particular plan they pay $2.50.The other insurance companies pay similarly. No patient ever pays the kind of charges mentioned above. Patients can and should ask ahead from the practice and from their insurance companies what their out of pocket cost will be.

    • Reply Ann |

      Darn the Kindle. No patient at our practice pays amounts mentioned above. And its evaluation not evaluate.

  • Reply Chris |

    I googled this because my doctor just recommended physical therapy for me. When the office called they set up 3 appointments a week for a month. I then asked what my co-pay would be. Turns out it is $81 a visit for “specialists”. $243 a WEEK??? That’s nearly a thousand dollars a month. I cancelled all the appointments.

    • Reply Ann |

      Chris–call your insurance company and ask what your copay will be. Insurance companies have many different programs depending on where you work and who is actually paying for your insurance (employer, union, you?). It’s virtually impossible for an office secretary to know what your copay will be unless he/she calls the insurance company or looks it up online. You can also likely get by with 2 x a week unless your prescription specifies. If you have a network to use be sure the PT practice is in your network or your copay/coinsurance will be higher. Also check to see if you have a deductible. I can’t believe how many patients don’t know if they have one and don’t know what one is anyway.

  • Reply Lisa |

    If you want to complain anything about a PT you have to file a complaint with the state board of Physical Therapy. You can get that info at your state’s dept of consumer affairs. Even complaints like excessive billing over state average work units aka reimbursement rates are looked into by attorney general’s office. No matter who a therapist works for, and whoever processes the bill, at the end the billing is legally the therapist’s responsibility, thus liability. Good Luck.

  • Reply Lori |

    Just another PT chiming in on the conversation. I see the initial post was in 2008, but has continued even just 6 months ago, so I thought I’d put in my 2 cents…or more. I have worked as a PT in some capacity for 17 years. I have been a worker bee in hospitals, outpatient clinics, and home health. I have been an outpatient clinic manager, spent time auditing PT claims for an insurance company, and also as an internal auditor for billing compliance for a large network of PT clinics. Personally, I agree with all the PT’s are saying on this site. And I agree with many of the comments posted by healthcare consumers (i.e. patient’s). In general, the system IS broken. On the consumer side, rarely do you walk into a clinic (or doctor’s office for that matter) and know what your bill is going to be. You have to wait for the provider to perform their service, bill it, and then for the insurance company to “adjust” the bill to what they think it should cost or what their contracted rate with the provider is. On the provider side you have people paying with cash, various types of insurance, and some who don’t pay at all. And when a patient walks in the door, you really don’t typically know what services you will perform until you evaluate them and make a treatment plan. So, you don’t know what the bill will be, or what their insurance will reimburse. It is a difficult balance on all sides. Patient’s want great care, and to feel better, and PT’s want to provide great service, help people get better, and feel valued for what they do.

    Typical “health” insurance reimbursement IS significantly less than actual bills. “Auto” insurance on the other hand often typically pays significantly higher reimbursements. The crazy part is that depending upon the payer, it is legal for a provider to charge, and be reimbursed for, different rates. And as much as people lambast it, Medicare is often one of the best payers…it just caps how many services you can get without the therapist jumping through hoops. But the hoops can be successfully managed with proper documentation. Medicare, worker’s comp and the Blue Cross/Blue shield PPO health plans often reimburse some of the fairest rates….around +/-$100 hr. I think it’s pretty reasonable depending upon where in the country you receive your services. I also had payers (CIGNA, United HMO’s that had $55/visit reimbursements). That doesn’t mean that any PT takes home that amount. Someone has to do the billing, lights have to be turned on and equipment purchased. When you consider the educational requirements for a PT (at this point, the minimum a PT has is a BS degree and 12+ years of experience, a Master’s degree (like mine conferred in 1997) with anywhere from new graduate to 19 years of experience, or an DPT…which could be a new graduate or someone with up to about 10 years of experience). It’s confusing. Regardless, they all have essentially 3 years of professional classroom education plus multiple internships under their belt. What does your doctor get reimbursed for the less than 10 minute visit that referred you to PT. I’m not saying they aren’t worth it, I am simply asking consumers to consider the time commitment. But often, PT doesn’t need to be 3x wk for 4 weeks….if you will do it on your own. Some people want their hand held, others don’t. We don’t know who you are ahead of time.

    So, if there is a concern about your bill, think about being a healthcare consumer. Demand to know what your charges be, but understand that there may be a range unless YOU have put in the time to call your insurance company and ask what your copay will be, what they reimburse, and what your deductible is. Ask your therapist if they charge for a Mercedes or a Yugo, and consider for yourself what you are willing to pay. Ask how much your health means to you, and why you went to the doctor in the first place. The MRI may give you an idea of what is wrong, but it won’t fix it. And the surgery won’t either….unless you do the rehab after. So don’t pay $5000 for surgery if you don’t plan to pay $5000, or more, for rehab.

  • Reply Ann |

    In New York state worker’s comp allows $83.32 for an eval and $49.50 for a visit. BCBS PPO is $60 a visit. Medicare is nowhere near $100 an hour. Some insurers allow a global fee and some allow by the modality or treatment. All patients going for any healthcare service should be aware of their patient responsibility. If you are paying privately ask what the charge is.

  • Reply Lori |

    I did not mean to offend. In general, I think PT’s are completely underpaid for the level of services most provide. And most consumers have no idea how little we really are paid for the amount of work we do. Regional differences do apply, as well as contracted rates. Medicare Reimbursement for PT eval in Central NY is $73.39. IF a PT does the service and designs a treatment plan, up to 3 more codes can be charged in the same day. PT eval is an untimed charge. Ther Ex is reimbursed $31.5 for 15 minutes attended, Making potential reimbursement for eval/treatment on the same day >$100. That does not take into account sequestration take backs of 1.5%. If a visit is 1:1 60 minutes of ther ex, then $31.5×4 = 126. Even if 3 units of ther ex are done and one of US, reimbursement could be >$100. Worker’s comp in NY must be significantly different than where I worked in FL where average reimbursements are closer to $100 for an hour of 1:1 constant attendance therapy. If you are using group charges, or seeing patients for less than 4 units of time, then certainly reimbursements would be less. Either way, even it it were $100, it is significantly less than most of these consumers are stating they are being charged. And I would say $100 would be “just enough”/fair to barely run a bare bones clinic with good staff. If your reimbursements are what you say they are, I would agree that it is unfair, and could barely cover your costs let alone do justice to your education. I did not mean to offend.

  • Reply Ann |

    Oh, no offense taken. Just giving our experience with the rates. The Medicare rates you quote are not reimbursements but the fee schedule. And the eval visit is often over $100 after you figure in patient’s coinsurance. But subsequent visits are closer to $75. Absolutely PTs don’t get paid enough–you are quite correct.

    The billing and follow up are the financial headaches!!

  • Reply Pat |

    I just received a bill for physical therapy services not covered by insurance as I have not fulfilled my $4100 deductible for 2015. The first session was $623 for an hour which consisted of $319 for the evaluation (paperwork mostly) then $147 for electric stimulation with a device, and $157 for manual joint manipulation. The next few visits were $314-$336/15 minute session plus $134 if the stimulation thing was used. I could not believe my eyes when these invoices arrived. These charges are higher than my knee surgeon charges for his office visits. In all, I am faced with a bill of OVER $4,100 for 7 15-30 minute sessions. Who is regulating these charges? My insurance company doesn’t care – they just pay it without questioning it. When I questioned the provider they said they are within the range for customary services. What can be done to curb this outrageous over billing for services?

    • Reply Peter |

      Pat, I have almost the same bills as you. I got the run around since day 1 on what the charges would be. Finally saw a bill 3 weeks in. I was at ATI PT in Naperville IL. BCBS is allowing >220 per visit. Outrageous.

    • Reply Ann |

      Did the information on these “allowed” amounts come from the provider or your insurance company? If only from the provider be sure to check your EOB or call the insurance company. Something isn’t right there. There are different amounts allowed in different parts of the country but in the Albany NY area the Blue Cross companies allow $60 a visit regardless of what is done.

      • Reply Peter |

        I could not believe it either. My BCBS EOB allowed the $220 amount. ATI PT billed for over $500 for EACH 60 min visit. 15 visits to ATI Naperville was billed to BCBS at over $7000.

  • Reply Ann |

    What insurance company is this? And where is the PT practice? The only part that would go to your deductible is what the company actually allows. A therapist could charge $1000 but if the insurance company only allows $50 then that is all that goes to the deductible. And all the PT gets paid. Those are super-inflated amounts.

    • Reply Peter |

      BCBS IL is allowing outrageous amounts. Is the PT charging with misleading codes that the insurance company can’t figure out?

  • Reply Ankur |

    I live in Albany NY and my Primary Dr referred me to visit PT for my sciatica type symptom. So I went there, first day they Evaluate me and created clan plan for (twice a week for 5 weeks, so total 10 visit + plus initial evaluation visit). Yesterday I got online claim form my insurance provider (UHC) and to my utmost surprise the first visit bill cost me $1043 (as in my high deductible plan) and when I called Hospital billing department to confirm this outrageous bill and they told me that this is true and so far (Initial visit + 2 subsequent visits) my total billed is around $1700. Then I called my Insurance provider (UHC) and they give me below details about service offered (mentioned in bill) to me on my 1st day along with CPT code and billed amount:
    1) CPT 97010 (Modality) – Billed amount $157
    2) CPT 97014 (Electrical stimulation) – Billed amount $150
    3) CPT 97001 (Evaluate) – Billed amount $627

    Now how can anybody justify $627 for PT Evaluation session (for roughly 15-20 mins). I’m planning to stop my entire future visits as this just outrageous, excessive and scandalous.

    Please suggest me how can communicate with hospital or flight against this scandalous amount?

    Thanks in advance!

  • Reply Peter |

    Pat, I have almost the same bills as you. I got the run around since day 1 on what the charges would be. Finally saw a bill 3 weeks in. I was at ATI PT in Naperville IL. BCBS is allowing >220 per visit. Outrageous.

  • Reply Ann |

    Ankur–You mention hospital billing. There are different amounts allowed for physical therapy at a facility vs. an office setting. If those are the allowed amounts you mention then you are right, that is outrageous. I don’t know the UHC allowed amount for PT in the office off the top of my head but I believe an evaluation 97001 allowed amount is no more than $90. Sometimes other codes are also billed at the eval and if an insurance company doesn’t do global fees, like CDPHP does or like EBCBS, then you have a situation where the allowed amount for each code is considered. It does add up. Ask UHC what the allowed amount for the same service is in an office setting.
    As for the bill you already have, contact the provider immediately and ask for consideration or a payment plan. You don’t want this bill to go to collections.

    • Reply Peter |

      Why would the provider consider terms? What is there incentive?

      Can we attack to for not being upfront with their costs? Not revealing the costs at time of service? Charging uncustomary rates based on Healthcare Bluebook prices? Do we have to take this to the State’s Attorney?

  • Reply Ankur |

    @Ann – Thanks for you comments. Yes I talked to UHC rep and then they told me that PT Evaluate (CPT #97001) allowed amount is $155 for that PT but what make difference here is Hospital setting Vs Office setting. As I went to Albany Medical Center PT facility therefore they charges extra (outrageous) charge for hospital facilities and not the care given to me at that time.

    PT office setting in my area is around $80-110 per session.

    Still I can’t believe that just for the sake of hospital setting (and not for the provided care) they are charging over the mount price and take away people brief and trust.

  • Reply Ann |

    Ankur–I am in the Albany area. Evals are around $81.59 (CDPHP) $47 (MVP) $68 (The Empire Plan, UHC) for outpatient PT. Subsequent visits are $54.50 for CDPHP, $42 for MVP, and $52 for The Empire Plan. Most insurance companies around here have a global fee that they allow for PT–doesn’t matter what or how much was done during the visit. That being said, it is always up to the patient, whether they know it or not, to know the provisions of their own health insurance plan. Office staff just can’t do it anymore–there are too many plans to keep up with. Even within the same insurance carrier benefits can depend on employer and type of policy.

  • Reply c mika |

    I just received a bill for two physical therapy sessions in January. Albert Einstein Moss Rehabilitation billed me $801.00 per session!!!!! The plan of care had been established in the prior year and these were the last two sessions. OMG! My insurance paid half and Moss wants the other $801.00 from me. I work for a major healthcare provider and am told I have good insurance. How are people suppose to live? I guess I will learn to live with the pain until my hip goes out at work.

    • Reply Ann |

      Did you receive an explanation of benefits from your health insurance carrier? Were these PT sessions billed as facility physical therapy? Your carrier should be able to tell you and anyone should ask whether their PT is being provided and billed as a faciity or as a professional. If you have to pick up the rest of the charge you really don’t have very good insurance.

  • Reply S.D. |

    Had PT in 2010 for bursitis or rotator cuff strain. Was living in a major metropolitan area at the time. Cost allowed by insurance was about $100 per session, and my co-pay was $20 or 20%. Sessions were about 45 min. Fast forward to 2015, I live in a different smaller metro area (Virginia Beach / Norfolk). Similar medical problem. Pre-treatment estimate was $150 per 30 min session, but actual billing was $250-$350 per session. I challenged this and finally the practice Team Leader agreed to bill me only for $150 per session. She was quite confused by her practice’s own pre-treatment estimate, and kept misunderstanding that my complaint was with my co-pay because I hadn’t yet met my deductible. That was not the complaint; I knew I would be responsible for 100% of the amt charged, not 30%. The issue was with the amt charged being twice what they projected. The treatment plan did not change. They simply flubbed the estimate. I will not return to that practice. Moral of the story: Get a pre-treatment estimate from the practice, and hold them to it.

  • Reply S.D. |

    Here are some #s:
    CPT 97001 $307 billed, $123 allowed by insurance
    97140 $140 billed, $123 allowed
    97110 2 units @ $130 each = $260 billed, $246 allowed

    This is more than my physician and surgeon charge per 15 min.

  • Reply J. |

    I stumbled upon this site doing a search and find some of these post almost criminal of what was charged by providers. Like “Ann” I run a PT practice in upstate NY and our reimbursed rates are criminally low. All our major HMO, PPO insurers are global based, meaning even if we billed $1000 per visit we are getting $42 and that is it, period. They range from $42 to $60. This is for a one on one, Doctor of PT, 1/2-45 minute treatment. We have not seen a decent increase in any companies fee schedule in the nine years in business and in fact in that time have seen our own premiums through one of these payers triple. We pay our bills but we also work and see patients from 8am to 6:30PM and spend additional hours after work and weekends doing paperwork from evaluations, reevaluations, discharges, and forms for authorizations for these company. We are in an rural area where there would be little ability to go cash base. It seems like many of these places are out of network with patients plan but never make the patient aware of it and then once the service is done hold them over the coals to get paid almost full amount charged. Big areas with lots of patients can do that but burn a few patients in a small area and see what happens to your referral source.

  • Reply C.L. |

    People need to understand that if they go to an outpatient physical therapy clinic that is owned by a hospital, they will most likely pay substantially higher out of pocket cost than if they went to a physical therapist-owned private practice. A physical therapist-owned private practice does not have near the negotiating power that a large hospital group has and is rarely able to get the same reimbursement rate as a hospital-owned facility. In addition, most hospitals own the majority of practitioners in their local and can force them (MDs / DOs / PAs / CRNPs / DPMs) to refer everything in house. So, when you think your hospital-owned practitioner (yes, they own you if you work for one) is looking out for your best interest when he sends you to hospital outpatient physical therapy, hospital MRI, hospital lab testing, hospital specialist, etc., he / she is actually doing what is in the best financial interest of the hospital he / she works for. Money Magazine in 2012 pointed out that an MRI at a hospital can cost three to four times as much as an MRI at a privately-owned imaging center. This holds true with almost all hospital-owned outpatient services even though the services are the exact same and maybe even inferior to privately-owned outpatient services.

    I’ve talked to many people on different hospital boards about this and their comment to me is that a hospital makes most of its money with outpatient services (which blew my mind as my father just received a $100k hospital bill for 9 days of inpatient care).

    It’s not that hospital-owned practitioners necessarily want to refer people in house, they don’t have a choice if they want to keep their jobs. Besides, hospitals will make it is much easier for their practitioners to refer in-house and administrators will do everything they can prevent anyone from the private sector from promoting their services to hospital-owned staff. In addition, most hospital-owned practitioners don’t have a clue what a patient is being charged for the services they perform (I bet they do know how many patients they have to refer in house to get their BONUS though). Hospitals have large billing departments and accountants that take care of that. Fortunately PATIENTS DO HAVE A CHOICE and need to start being responsible stewards of their healthcare dollars.

    As I read through the posts, it appears there is quite a discrepancy what people say they are being charged and what physical therapists who own clinics say they are charging or being reimbursed. I would bet that almost every customer above complaining of outrageous physical therapy charges either went to a hospital-owned or physician-owned outpatient physical therapy clinic.

    What is driving up cost and undermining quality of care in American healthcare is financial relationships between unrelated medical services (fee for referral, even if indirect).

    If you are a healthcare consumer that wants to keep your cost down and your quality at a premium, ask questions and find a quality independent (no financial relationships with referral sources) private practice and I think you will be satisfied and your cost will be significantly reduced.

  • Reply S.D. |

    Thank you for the info, C.L. I was just burned by the higher “outpatient hospital” billing rate at a PT facility. Thought they would be billing PT at “office setting” rate (since it was in office setting;), but no. Next time, will look for independent facility.

  • Reply Mike G |

    I don’t think many of the PT’s here value the care they give. If you’re giving hot packs, a few basic exercises and time on a bike then yes, you can’t justify the amount patient’s are charged. I see most patient cash and charge $200 for an evaluation and $150 a visit and never has a patient once said that it wasn’t worth it. See every patient one one one, use your manual skills, properly assess the entire body and treat them as a whole and I’m pretty sure people will think higher of us and our skills.

  • Reply James Longworth |

    Physical Therapist pay is an insult and a very poor 7 years of educational investment! Too much education and costs associated with getting and maintaining a license. I DO NOT recommend the profession to anyone! The salary range for the profession is a complete insult and joke! Everyone makes money off us working and the profession does nothing to ensure a competitive salary commiserate with education and licensure requirements. Go to school 1 more year and do a residency and make 3 times the income and get the respect deserved helping improve people’s life. Health care is not appreciated, only demanded, in the USA and the educational requirements along with professional requirements as well as bureaucracy between states! Better yet, give a crap about people and make a killing more!

So, what do you think ?