How Much Does Physical Therapy Cost?

If you’ve been wondering how much physical therapy costs, don’t worry—you are not alone. This is a question we get a lot. While it can be quite complicated, we will try to answer it as best we can.

The first thing you should know is this: it depends. We know, that sounds like a cop-out and the same thing everyone else says. But we promise we will explain why and give you enough information to feel confident.

Why Do We Say “It Depends”?

The cost of a physical therapy session can vary greatly. This is because:

• Insurance Plan:  Different insurance plans have different contracts and payment structures with each clinic. For example, one insurance may have a contract that sets their rate at $90 per visit, while another may have a contract closer to $130 per visit. To make things more complicated. Some plans have a set rate, while others have a variable rate that depends on what is billed.

  
  

• Where you go:  Insurances have different contracts with different providers. In general, large networks like hospital systems or corporate-owned clinics can leverage their size for more favorable contracts. This means their reimbursement rates can be significantly higher than those at a small private practice like HealthSpan PT. This can lead to higher copays, higher coinsurances (20% of $200 is more than 20% of $150), and overall higher rates for you. Read more about this HERE.

  
  

• Patient Responsibility:  Your out-of-pocket cost depends on the details of your insurance—things like whether you have a copay, a coinsurance percentage, or whether you’ve met your deductible. If you aren’t sure what these terms mean or the difference between them, you can learn more about it HERE.

  
  

• What you do:  We are required to bill using specific CPT codes that describe each treatment or service. Unfortunately, we can’t just bill your insurance for “1 physical therapy visit.” Trust us, we wish we could—it would make our lives much easier. Some of these codes include manual therapy, therapeutic exercise, neuromuscular re-education, and electrical stimulation. Billing these codes can get extremely complex and confusing, but ultimately, what is charged can make a huge difference in how much your visit costs. Some codes reimburse much higher than others. Generally, exercise codes pay more than electrical stimulation or manual therapy, since research has consistently shown exercise is the most effective way to recover.

  
  

• Appointment length:  The length of your visit can change the cost. Some clinics see patients for 30 minutes, others for an hour. The trend over the last five years has been shorter visits because reimbursement rates from insurance companies have continued to decline despite high inflation. At HealthSpan Physical Therapy, we currently see our patients for 40 minutes per visit.

  
  

• Visit Type:  The type of visit also matters. An initial evaluation (your first visit) typically costs more than a standard follow-up. This is because of the extra administrative work required to add you as a patient and the expertise needed to diagnose your injury and develop a plan of care.

How to Estimate Your Cost

Ultimately, calling us and having us do a free benefit check will give you the most accurate estimate of how much your visits will cost. However, even we can’t guarantee 100% accuracy, since it’s not uncommon for us to receive incomplete or inaccurate information during benefit inquiries.

If you’d like to estimate yourself, here are some ways to do so:

1. Do you have insurance? What kind?

   As stated above, different insurance types have different reimbursement rates. For example, if you have a plan like BCBS, you will likely pay more than someone with Blue Care Network. Below is a general ranking of some common insurances we see at HealthSpan PT:

   • Higher rates: BCBS, Medicare, most Medicare Advantage plans, McLaren Health Advantage

   • Medium rates: Aetna, Priority Health, Humana

   • Lower rates: Blue Care Network, UHC, HAP

   • Medicaid plans are not listed, as they typically do not have patient responsibility.

2. Where are you going to PT? Several factors matter:

   1. As discussed earlier, if it is a large hospital system, it will likely be more expensive than a smaller private clinic.

   2. How long are their appointments? Longer appointments may cost more.

   3. Are they in-network with your insurance? Out-of-network typically costs more.

      
      

We are not aware of the specifics of how other clinics are reimbursed, but HealthSpan is typically reimbursed anywhere from $70–$120 for an average follow-up appointment.

Here’s how to estimate:

1. Check if your deductible has been met.

   • If it has not been met, look at the insurance ranking above, then use the $70–$120 range to estimate. For example, if you have Aetna (medium rate), you might estimate around $90 per visit until your deductible is met.

     • Note: Some insurances cover physical therapy even if your deductible has not been met, sometimes with only a copay.

2. If your deductible has been met:

   1. If you have met your deductible, the next step is to find out if your insurance has a co-pay or a coinsurance for physical therapy.

      1. If you have a 20% coinsurance and you have the Aetna example above, your cost could be about $18 (20% of $90).

      2. If you have a $20 copay, then that’s your flat rate per visit.

   2. If you don’t have a copay or coinsurance, you may have no patient responsibility (yay!).

Even two patients with the same insurance company might pay different amounts if their plans have different negotiated rates with the provider.

Cash Pay

In order to still be able to help patients without insurance, clinics often have their own self-pay rates, which can differ based on business policy and services offered.

Healthspan Physical Therapy Cash Rates:

At HealthSpan PT, we keep things simple with flat-rate pricing for cash-pay visits:

• Initial evaluation: $110

• Follow-ups: $90

We find that this makes things easier for everyone. We don’t need to worry about billing details and can focus on providing the best treatment for you. And as the patient, you know exactly what to expect.

Now do you see why we say “It depends” when someone asks how much PT costs?

We hope you found this to be helpful and give you at least an idea of how much a physical therapy visit will cost. It is obviously quite complicated and highly variable

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HealthSpan Physical Therapy is happy to help with benefit analysis and estimations. Give us a call and let us help!

Get a Free Benefit Analysis!