HOW MUCH DOES P.T. COST?

FORBES HEALTH

www.forbes.com

by

Anna Baluch

Rachel Tavel PT, DPT, CSCS

If you’re navigating an injury, illness, disease or disability, your health care provider might recommend physical therapy, which may help reduce pain levels and improve mobility and function. While physical therapy offers a variety of benefits and has the potential to improve your quality of life, it’s typically not available for free. Read on to learn about how much physical therapy costs, including various factors that may influence the amount you pay.

The Average Cost of Physical Therapy

“The raw cost of physical therapy without insurance [varies] depending on the appointment type and setting,” says Okon Antia, a board-certified physical therapist and owner of Campus Motion Physical Therapy and Cryo Sports Recovery in Houston, Texas. “An initial evaluation visit at a private office [typically costs] between $150 and $200. At a hospital facility, [the cost] would range from $400 [to] $500. A follow-up visit [may cost] $80 to $120 at a private office and $300 to $400 at a hospital facility,” he adds. These numbers will vary based on region as well as other factors.

“Insurance coverage for physical therapy has declined significantly over the past 5 years, thus dramatically reducing physical therapy practice profit margins,” notes June Srisethnil, a physical therapist and a board-certified orthopedic clinical specialist (OCS) in Portland, Oregon. “As the cost of doing business has increased, the cost per physical therapy session before insurance has increased nationwide,” she adds.

Contributing Factors to the Cost of Physical Therapy

Dr. Srisethnil explains that the cost of physical therapy involves both direct and indirect factors. “Direct factors are driven by the type of service provided, length of session, provider specialty, geographic location and contracted reimbursement rates from insurance companies,” she says. Indirect factors include the total cost of attending physical therapy based on an individual’s unique circumstances, such as needing to take time off work for appointments, whether there is a waitlist, the cost of delayed care in the event medical services are not immediately available, any co-payments for primary care visits prior to a referral and the cost of childcare to attend appointments, she adds.

Does Insurance Cover Physical Therapy?

Insurance may cover physical therapy, but every insurance plan is different, explains Dr. Antia. “Some insurance plans have a consistent copay of, say, $25 to $50 per visit, no matter what services are rendered. Once you pay the copay, [insurance will] cover the rest,” he says.

“Other insurance plans require you to meet your deductible first (which could be $2,000 to $5,000) before they kick in and help with the cost. On those plans, your [cost] responsibility as the patient is based on what services you receive and for how long. More services for a longer duration are more expensive for you and the insurance company unless the insurer caps charges at a [maximum] rate,” continues Dr. Antia.

According to Dr. Srisethnil, fewer and fewer insurance companies are covering physical therapy services before a deductible is met. “These deductibles [can also be] very high—commonly up to $7,000 per individual. In addition, many insurance companies require a referral from an authorizing provider,” she says. However, direct access laws are determined by state and allow patients to see physical therapists without a referral from a primary care provider.

Reach out to your health insurance provider to better understand how exactly your specific plan covers the costs of physical therapy so you can plan for the care you need.

Estimating the Cost of Physical Therapy

The cost of physical therapy without insurance depends on the type and complexity of injury or condition being treated, as well as the treatment length and type of setting, such as a private practice, physical therapy chain or hospital. In the table below, Dr. Srisethni estimates the total cost of physical therapy treatment for two common injuries without utilizing insurance based on the assumption that each session costs $120. For personalized cost estimates, consult your physical therapy and insurance providers directly to discuss your unique needs and coverage.

Who to Speak With About Physical Therapy Treatment Costs

Dr. Antia recommends contacting the front desk of any physical therapy office to learn about its rates. “If you have insurance, they’ll verify your benefits and give you an estimate of your out-of-pocket costs. If you don’t have insurance, they’ll quote you the self-pay/cash rate and [inform you] if there are any discounts applied to that rate,” he explains.

“Sometimes you can get a discount on the self-pay/cash rate if you prepay for a certain number of visits. [Typically], the more visits you pre-pay, the greater the discount per visit [you receive],” adds Dr. Anitia.

“As a result of the No Surprises Act, effective Jan. 1, 2022, patients are legally entitled to a “good faith estimate” from all medical providers upon request after an appointment is made but before the start of care,” notes Dr. Srisethnil. A good faith estimate is the anticipated total cost of care for the entire course of treatment, she explains, and it can be particularly helpful in planning for costs of care.