Physical Therapy Cost
Physical therapy costs can vary greatly depending on where you see a physical therapist. You can see a PT in the hospital, the outpatient clinic, inpatient rehab, wound centers, K–12 schools, and so on.
For today's discussion, I will be writing about the outpatient orthopedic setting. The first thing to discuss when talking about the cost of physical therapy is: who is the insurance provider? Are they "in-network" or "out of network" with that provider? Are you 65, and do you have Medicare? Let's break these down for a better understanding of what the cost of physical therapy will be in an outpatient clinic.
What is “In Network”?
"In network" basically means that the physical therapy provider has a contract with that insurance company and is obligated to accept the agreed-upon rates in the contract.
Your "in-network" insurance will pay a certain percentage or set fee per session for PT after the deductible is met. Deductibles are higher than ever now, so they can range from $500 to $10,000.
If your deductible is $2000 and you have met that deductible, then your session will typically cost around $10–50, depending on your co-pay or co-insurance. The co-insurance is typically 10–30%, and the copay is a predetermined amount.
You will have either a co-pay or co-insurance but not both; this is plan-dependent. If your deductible is not met, you will pay anywhere from $75 to $200 per session for a PT session until that deductible is met. Deductibles can be met by seeing specialists, having procedures, surgeries, MRIs, etc.
What is “Out of Network”?
"Out of network" is a situation when the physical therapist is not contracted with that insurance provider. These therapy companies can charge whatever rate they want, and the "out of network" benefits are typically different percentages for co-pays.
Many "out of network" clinics will charge $150-300 per session and provide superbills to the patients to self-administer to their insurance companies. They might reimburse anywhere from 40 to 70% or credit that percentage to their deductible.
This deductible is different than your "in-network" deductible. Most "out-of-network" deductibles are significantly higher than your "in-network" deductibles.
Medicare is for people over the age of 65 who are no longer working. Medicare has a deductible of around $225 per year, with a slight increase every year. It covers 90% of physical therapy fees, and most people have secondary insurance to pick up the remaining 10%.
The vast majority of Medicare patients at CORE Therapy & Pilates do not pay anything as soon as their deductible is met.
Watch this video to learn more about Medicare.
CORE Therapy & Pilates is a hybrid clinic that is "in-network" with Medicare and Blue Cross Blue Shield. We are "out of network" with all other providers.
We charge up front for all "Out of Network" clients but we bill for them instead of providing SuperBills for the patient to submit. This takes the responsibility away from the patient, who would otherwise have to deal with their insurance companies on their own.
Here is a blog with more information about Medicare.
How much does physical therapy cost with Medicare?
These are some of the major things that impact the cost of physical therapy in an outpatient clinic. Another thing to consider is if the clinic is affiliated with a hospital. If so, then they will charge significantly more and get paid significantly more than the therapist-owned clinic.
I have had patients report that they would pay a $100 co-pay for PT and then get a bill for $400–500 for the remaining amount for that session to meet their deductible.
Does all insurance cover physical therapy?
This is plan-dependent. Medicare covers physical therapy and is the cheapest option for the consumer by far. However, because not all physical therapy outpatient clinics accept Medicare, it can be difficult for Medicare patients to find physical therapy services in their area.
Private insurances typically cover physical therapy, but not all plans cover "out of network" physical therapy.
Who can a prospective patient speak to about physical therapy costs?
Prospective patients can call the local outpatient clinic to inquire about costs and insurance benefits. When someone calls our clinic, we ask a few questions about what is going on and what kind of help the prospective patient needs.
From that discussion, we can determine if we are a good fit for each other. Then we obtain the insurance information from the patient and call the provider ourselves to verify the benefits.
Every private plan is different as far as being in or out of network, deductibles, co-pays versus co-insurance percentages, and so on.
Check out this article to learn more about the cost of physical therapy.
Examples of injuries and how much physical therapy is needed?
Now I want to write about a few types of injuries, typical treatment lengths for different ages, and the total cost without insurance.
Low back pain is the most common injury we treat. An active 35-year-old would require 4–7 sessions of PT at a cost of $150–350 per session. A sedentary 55-year-old may require 8–12 sessions at the same cost per session, and the 65-year-old's average length of PT care is 14+ sessions, covered by Medicare.
An ankle sprain for a teenage athlete would take 2–5 sessions to get back to sports, and a 50-year-old who tripped hiking might take 5-10 sessions to get back at it.
An ACL surgery that needs to be rehabbed back to college sports would take 8–10 months of consistent PT, twice a week. The same surgery for the 40-year-old who tore his ACL playing old-man softball would be a completely different rehab process that would take 10-15 months.
A vestibular patient suffering from vertigo will typically respond to PT in 1-3 sessions.
Final Thoughts
The cost of PT depends on many factors. The insurance plan and the specific benefits of each potential patient are the main factors. Is the physical therapy facility cash-only (all out of network), "in network’," taking Medicare, or a hybrid of these models?
Does the physical therapist spend an hour with you one-on-one, or are you in a big treatment room with them juggling four other patients at the same time? Is it a specialty need like pelvic floor PT or vertigo?
I have been a physical therapist since 1998 and opened my first PT business in 2001. My current outpatient clinic is a one-on-one hybrid model, and we have been serving Austin | Westlake Hills since 2005.
Now that you have a better understanding of physical therapy costs, call 512-215-4227 to get started with us at CORE Therapy & Pilates for your physical therapy journey!