Is Physical Therapy Covered by Insurance?

The cost of physical therapy (PT) varies and depends on whether you have health insurance. 

Physical therapy might be covered by your insurance plan, either partly or in full. To find out if your insurance will cover PT, you will need your healthcare provider to confirm that PT is medically necessary. This applies to private and other insurance plans, including Medicare, and worker's compensation insurance.

Physical therapy typically requires several sessions. Even if your insurance fully covers the treatment, the costs of physical therapy can still add up because of your co-pays. 

If you only have partial coverage from your insurance, you'll have to factor in that cost as well as the portion of the service fee that you're responsible for paying.

Here's what you should know about how much physical therapy costs with and without health insurance. 

Questions to Ask Your Insurance Company

Ask your insurance company about coverage before you schedule appointments and start physical therapy (PT). 

Your insurance company can help you figure out how much you will likely end up paying for each PT session and what requirements need to be met for PT to be covered. 

Is Physical Therapy Covered as Part of My Plan?

Check if your insurance plan actually covers physical therapy and if so, what part of the cost you'll have to pay. If physical therapy is not covered, you'll pay the rate that your insurer sets with the physical therapist.

If you have coverage, ask whether you will have to pay copays (a set fee for each visit) or coinsurance (your insurance pays a portion and you pay a portion). Most people have a co-payment of about $25 to $35 per physical therapy session. However, co-payments can be as high as $50 or $100.

If you have Medicare as your primary insurance, your plan will cover about 80% of the claim for PT, and you may have to pay the remaining 20%. If you have Medicare and secondary insurance, check if the secondary insurance will cover all or a portion of the remaining bill.

What Is Insurance Cost-Sharing?

Many people have insurance plans that include cost-sharing. In this arrangement, some of the costs of services are covered by your insurance carrier and some out-of-pocket costs are your responsibility.

You may also have a co-payment to pay each time you visit your physical therapist. You may have a deductible to meet each year before your insurance coverage will start paying for PT.

Is a Referral Needed?

For coverage to kick in for physical therapy, you may need a referral from a healthcare provider stating that you need to have PT (medically necessary).

In some cases, certain tests, such as imaging as part of a diagnosis, might also be needed. 

Are There Limits on the Coverage?

If your insurance covers physical therapy, ask if there are limits on the coverage. 

For example, there could be a limit on the number of appointments per year or per condition that will be covered.

Ask about limits for the following:

• Number of physical therapy appointments
• Amount of time you can get physical therapy
• Costs that are covered

Do I Need to Stay In-Network?

Ask your insurance if you need to stay in-network when you look for PT. If you're able to go out of network, ask about the difference in costs between in-network and out-of-network providers.

Once you choose a physical therapist, check to see if they are a participating provider with your health insurance company. Staying in-network can keep your costs down. If the therapist you want to work with is in-network, provide them with your insurance information. From there, the therapy office will submit claims for payment to your insurance company.

Does the Plan Cover PT Equipment?

In some cases, your physical therapist may recommend that you use certain equipment or devices at home as part of your therapy. Ask your insurance company if these devices are covered. 

Questions to Ask Your Physical Therapist

After you have contacted your insurance about coverage, requirements, and limits, check with your physical therapist to get an estimate of potential costs.

How Are Therapy Services Billed?

Understanding how therapy services are billed will help you to find out what your out-of-pocket costs could be. Physical therapists bill for their services based on what they do during sessions. 

For example, your first visit is an initial evaluation and it's usually billed at a higher rate than follow-up sessions. During follow-up therapy sessions, your therapist may bill for the different treatments they do.

For example, if your therapist does an ultrasound, joint mobilization, and prescribes exercise during your session, three separate units of therapy will be billed. Each unit will have a different charge, and adding up the charges will give you the total cost billed.

Co-Payments Can Add Up

PT is often ongoing and not just one appointment. You may need to go several times each week for weeks or months, depending on your recovery. Even if your co-payment for a session is small, the costs can add up over time.

What Are the Costs Without Insurance Coverage?

If your insurance does not cover physical therapy or only offers partial coverage, you will have to pay for some or all of your PT yourself. When you contact your physical therapist’s office, tell them that your insurance does not cover your therapy and that you will be paying out of pocket.

The office can provide you with a fee schedule that lists the amount charged for each separate service that will be provided by your physical therapist.

Once you have a copy of the fee schedule, talk to your therapist. Make sure that you understand which services will be offered and billed. You can decide if the treatment plan is something you can afford.

For example, if your therapist is planning to do electrical stimulation, therapeutic activity, and therapeutic exercise during your treatment, add up what each service costs to get an idea of how much the entire session will cost.

How Do Sliding Scale Payments Work?

Your PT office will work with you to provide the best care at the lowest cost. For example, they may offer a sliding scale payment plan where you pay a set amount based on your income or set up an interest-free payment plan that allows you to pay off the cost of your sessions over a few months instead of with one big payment.

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Factors That Affect PT Cost

There are a few factors that can affect how much physical therapy will cost. Keeping these points in mind when you're estimating how much you may have to pay to have PT will help you prepare.

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Surgery or Injury Recovery

If you have had a sports injury like a sprain or strain, you may only need a few sessions of physical therapy. Many people go to PT after a minor injury to learn what to do—and what not to do—while they're healing.

Your therapist can teach you self-care exercises to do while you're recovering. In that case, your total cost of physical therapy could be less than $100 if you have insurance or several hundred dollars if you're uninsured.

If you have had major surgery like a joint replacement or fracture repair, you may need to go to physical therapy for several months. In that case, your out-of-pocket expenses could add up a lot.

If your surgery is elective and planned, try to budget for it. For example, having some extra cash on hand to cover several co-payments a week for a few months will be helpful.

Equipment

Your physical therapist may recommend items you can buy to help with your recovery. You will probably have to pay for these items yourself. 

Examples of equipment you might need to buy for PT include:

• Lumbar roll
• Cervical roll
• Exercise ball
• Balance board
• Kinesiology tape
• Shoulder pulleys
• Resistance bands
• Assistive devices like a cane or crutches (especially if you'll be progressing with gait training after surgery)

Your health insurance plan may or may not cover equipment for PT. If your therapist recommends you buy any of these items, ask them to recommend affordable options.

Keep in mind that you do not necessarily need to buy top-of-the-line equipment. You might even be able to make some items yourself at home—for example, a lumbar roll or shoulder pulley.

Finding Affordable Physical Therapy

One of the main ways to save money on physical therapy is by seeing a therapist who is in-network for your insurance (because seeing a provider that's out of network will cost you more).

You can call your insurance carrier to ask if a PT is in-network or search for providers online.

If you're worried about how you will pay for physical therapy, tell your therapist right up front. You can talk to them about how to get the care you need while keeping costs low.

The skills and motivation offered by a licensed physical therapist are essential to your recovery, but your therapist can also show you what you can do on your own. Not only will this empower you to be actively involved in your recovery, but it could also help you save money.

For example, you might be able to make PT more affordable by:

• Support a speedy recovery by following your home exercise program
• Doing therapy on your own at home and visiting the therapy clinic a few times a month for “booster sessions” (rather than several times a week)
• Ask about telehealth options (ask about insurance coverage and out-of-pocket costs compared to in-person appointments)

You might be able to reduce your physical therapy costs in other ways, such as:

• Using a health savings account (HSA) or flexible savings account (FSA)
• Asking your PT clinic or provider if they offer lower prices for services if you pay in cash (sometimes called "self-pay")
• Reaching out to patient advocates, financial assistance departments, and community resources and ask about payment arrangements or other kinds of help paying for your medical bills
• Getting an explanation of benefits (EOB) and itemized list of charges for all your medical bills to make sure there are no errors
  

Summary

The cost of physical therapy (PT) can vary based on the type of treatment, how long you need to attend PT, and whether or not you have insurance.

If you have insurance, contact your health insurance provider and ask about coverage for PT before you call to make an appointment with a PT. Even if your insurance will cover PT, you will most likely need to have money for the co-pay costs for sessions.

If you do not have health insurance or if your insurance does not cover PT, you will have to pay for it yourself. It is worth discussing ways to save money on PT with a therapist, such as payment plans or doing exercises at home.

Working with a physical therapist can make all the difference if you're recovering from an injury or surgery. Unfortunately, the cost of therapy services can be steep and may prevent people from realizing the gains they could make by going to PT.

If cost is a barrier to treatment for you, reach out to your provider or a local PT office and ask how you can get the best care that you can afford.

Frequently Asked Questions

• Which insurers cover physical therapy?

  Most health insurers, including Medicare and Medicaid, will cover all or part of the cost of physical therapy services. Private health insurers will often cover a portion of the cost for PT as well.

  You may have cost-sharing for PT, like meeting your insurance deductible or copays. Contact your insurance carrier to see if PT is a covered service.

• What is the out-of-pocket cost of physical therapy?

  If you have health insurance, your copay for PT will probably be fairly low, like $25-$30 per session. If you don't have insurance, PT could cost you hundreds of dollars out of pocket.

• Is there a co-pay for physical therapy?

  Most insurance companies cover a portion of the physical therapy bill and leave the rest for you to cover with a copay. This payment will need to be made for every PT session you attend. Ask your insurance company about your financial responsibility for PT before you make your first appointment.

A knee replacement is a surgery that involves replacing the damaged components of the knee joint with artificial components. Severe osteoarthritis, rheumatoid arthritis, and injuries are the most common reasons why people get knee replacements. These conditions cause significant pain that severely impacts mobility and daily function.

A knee replacement is a major surgery that requires thorough planning. The doctor will ask you several questions to determine if you are right for the procedure. This will cover areas such as your medical history, current levels of pain, function level, and commitment to recovery and rehabilitation.

In this article, we will talk about the 5 things to consider before getting a knee replacement.

#1 The Type of Implant and Surgery

An orthopedic surgeon can perform either a partial or total knee replacement. In a total knee replacement, the entire knee joint is replaced with an artificial implant. The type of implant that will be used can vary. You should talk to your doctor about why a certain implant is best for you. Your knee replacement may be performed using a minimally invasive technique, with the use of miniature tools and a camera. Talk to your doctor about the specifics of the implant and surgical technique that will be used, and what that entails.

#2 The Reason for Surgery

Knee replacement is usually performed to relieve pain from arthritis or other conditions that damaged the joint beyond natural healing. If your pain can be managed with other treatments, such as medication or physical therapy, you may not need surgery. Surgery should always be considered as a last resort after all other treatment options have been exhausted without success. Before going under the knife, make sure you’ve tried everything else, including but not limited to weight loss, activity modification, physical therapy, and corticosteroid injections.

#3 Your Age and Health Status

Knee replacements generally work best for people who are healthy enough to tolerate major surgery and rehabilitation. People over the age of 60 are considered the ideal age for a knee replacement, while those over age 80 or those with serious health problems such as heart disease or lung disease may not be good candidates for this type of procedure.

#4 The Recovery Period

Depending on the individual case, full recovery from knee replacement surgery usually takes between three to six months. However, some people may require up to a year before getting back to normal again. Patients who know what to expect after surgery are more likely to be satisfied with the surgical outcomes.

#5 The Surgeon’s Experience

When choosing a knee surgeon, it’s important to find one who has significant experience performing knee replacements. Ask about their success and complication rates. Also, ask if they participate in continuing medical education courses on advances in joint replacement surgery. Even if the surgery can be performed with less invasive techniques, the risks are still present, even more so with a less experienced surgeon.

Knee Replacement Surgery in Boynton Beach, FL

Place your trust in the board-certified and fellowship-trained orthopedic surgeons at Personalized Orthopedics of the Palm Beaches. We perform knee replacements on a regular basis and also provide physical therapy services, which we make available on-site. Our team is dedicated to providing you with the highest quality comprehensive orthopedic care in Palm Beaches. To schedule an appointment with one of our orthopedic surgeons, call our office today at (561) 733-5888 or use our convenient online request form.