What is cash-based physical therapy?

In a cash-based treatment model, the physical therapist enters into a contract with the patient to provide physical therapy services in a manner that both parties have determined will help them reach treatment goals most efficiently. The patient pays in advance or at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low.

Typically, coding for physical therapy services provided (CPT codes) is determined using a complex matrix of "timed codes" and "untimed codes". This often results in confusing patient bills, as the amount billed to insurance will vary from visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision-making between the patient and their provider. Documentation for evaluations, treatment visits, and progress notes are performed just like any physical therapy practice and comply with all legal requirements.

Unfortunately, we are not able to provide services to anyone covered under Medicare Part B. Under current Medicare regulations, it is illegal for a physical therapist to accept cash pay from Medicare patients for services that may be covered under Medicare, even if the services provided meet all treatment, documentation, and HIPAA requirements and have been prescribed by their physician.

Can my insurance be billed for cash-based physical therapy services?

Most insurance companies, except Medicare, Medicaid, and some HMOs, will provide payment for services received “out of network”. Going out of network means you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network to see the physical therapist they choose. Upon request, we will supply you with an invoice that you can submit to your insurance company. The insurance company may pay you rather than paying the provider.