Physical Therapy: Understanding the Costs Associated with Rehab

You just got back from a fun weekend in the mountains, twisted your knee and your Doctor correctly recommends you to Physical Therapy. You’re excited about feeling better but concerned about how much it might cost. The cost of healthcare can be confusing and difficult to understand.

I wish it was as simple as here is the standard price per session but there are many different variables that can affect the cost of physical therapy. The total costs depend on your location in the country, your type of insurance, what type of facility you go to, and how many visits total you will need. We will do our best to try and give you an idea of how much Physical Therapy might cost and some tips to make it less expensive.

Disclaimer: To get the actual costs, you will need to call your insurance provider and contact the clinic where your Physical Therapy will be administered. We have provided examples and estimates only.

Average Physical Therapy Costs

To help breakdown the costs by insurance, we’ll give some examples of the average cost of Physical Therapy.

Outpatient Physical Therapy Clinic

Most physical therapy service fees are based on Medicare charges, even if you have private insurance. The average physical therapy visit will cost between $60-$200 depending on a few factors.

The first visit will have a hire expense. This is an initial evaluation and is used to determine the correct diagnosis, what the prognosis is, and how to best proceed. This visit also requires the most time and paperwork. This visit may not provide a lot of treatment but the goal is to figure out what’s going on and to get you feeling better faster.
After the first visit, the following treatment session costs are based on how much time and what services are provided. If your follow-up appointments are only 30 minutes then these should cost less than if your appointments are 60 minutes long.
The other variable is how much and at what point insurance begins to start covering services.

However, your copay is the same whether you’re seen for 5 minutes or 60 minutes that day.

To have a better understanding for our future examples we will use these averages below:

Initial Evaluations: $120-$200

Follow up Visits: $60-$150

Without Insurance Example: If you did 10 Physical Therapy treatments without insurance the total cost would be around $1,200 over a 4-6 week period. Your final costs will depend on deductibles, insurance plans, and copays.

Important to note that the average amount of visits per episode of care can vary greatly between clinics. Our clinic hovers between 5-6 visits per discharge reducing those costs in half. Feel free to ask your therapist how many visits they recommend at your initial evaluation.

With insurance Example: In this example health insurance plan provided by Blue Cross Blue Shield, the deductible is $300 and the copay is 25$ per visit. Therefore for 10 visits on this plan, physical therapy would cost between $475-600.

Comparing the Cost of Physical Therapy VS an MRI or Surgery

$1,200 might sound like a lot of money for 10 visits until you compared it to other treatment options. For example, the average cost of an MRI is $2,000 but then you still have to have treatment done on top of that.

Many people want to wait for an MRI before starting physical therapy but we recommend just the opposite. It’s better to do Physical Therapy before an MRI to save money and reduce your changes of having surgery.

Average Cost of Medical Services
Average of 10 Physical Therapy Treatments	$800 - $1,400
Average Cost of One MRI of the Lumbar Spine	$2,065
Average Cost of One Back Surgery	$112,000
Average Cost of One Visit to Orthopedic Surgeon	$300-$500
Average Cost One Steroid Injection	$200-300 ( does not include doctor visit fee)
Average Cost of a Knee Replacement	$50,000

In addition, Physical Therapy has been shown to have great long term success, greater patient satisfaction numbers, and is a great way to learn how to prevent an injury from coming back.

What is a Health Insurance Deductible

A deductible is the payment amount that you are responsible for before your insurance begins to cover payments. As an example, if your deductible is $3,500 then you pay the first $3,500 of charged services, and then your insurance will begin to cover services at the contract rate after that. There may still be a co-insurance or a copay after the deductible is met.

According to ehealthinsurance, the average health insurance deductible is between $4,364 and $8,439 for a family. This may be lower for individual health care plans.

One Important Note: You are essentially a cash-paying patient until you reach your deductible.

Out-of-Pocket Max

For private and even some supplementary insurance, there is an out-of-pocket maximum payment that must be met. That means once you have met your deductible and paid up to a certain limit, you no longer have to pay any additional money, including for copays or coinsurance payments.

For example, your out-of-pocket max might be $9,000 and your deductible at $3,500. You would pay all of the cost up to the deductible of $3,500 and then a portion of each medical bill until you reached $9,000. At that point, you wouldn’t have to pay any more out of your own pocket and the insurance company would cover the rest of your medical expenses for the year.

Physical Therapy Costs Will Depend on Insurance

There are a few different insurance options that we will try to address in this section. These include federal and state payers such as Medicare and Medicaid, private insurance, and physical therapy with no insurance.

Medicare

Medicare covers 80% of the costs for Physical Therapy and the patient is responsible for the remaining 20%. However, most people with Medicare also have supplementary insurance which typically covers that remaining 20%. Therefore, unless there is some type of treatment being performed that medicare does not cover, your physical therapy services should be fully covered by insurance after you’ve met your supplementary deductible. There is a limit for how much therapy you can have in the year but your therapist should be tracking it.

Medicaid

This will depend on each individual state and how they run their state medicaid program however costs are minimal. For example, the copay for Medicaid in Colorado is a $2 copay and the rest is covered. There are some restrictions associated with Medicaid but this is more pertinent to your provider than it is for you to know.

The other point to make, Medicaid is not accepted by all clinics. It’s important to clarify that the clinic you are going to does take Medicaid. If you can’t find a clinic that does, be sure to check out the regional hospital or medical center.

Private Insurance

This is the insurance that will have the greatest disparity in costs because it depends on your individual plan and insurance provider. Most of these plans will have a deductible and a copayment. As an aside, some of these insurances also have visit limits each year so be sure to check on that before undergoing a major surgery to plan ahead.

No insurance/Cash Pay

One of the benefits of paying cash for physical therapy is that there is often a discount. It is typically a 20-30% discount so be sure to ask if there is a cash option. As a tip, some people with pay cash and the submit receipts and notes to the insurance

Do You Need a Prescription for For Physical Therapy

No, you do not but this does depend on which states you live in. This is called Direct Access and allows you to go straight to the Physical Therapist for treatment saving you important time and money. The faster you get in, the easier an issue is to fix. Direct Access is becoming more common and within a few years will be the norm.

It also does depend on your insurance. For example, Blue Cross Blue Shield allows for 6 visits before a Doctor’s referral is needed to continue.

In the map below you can find the states the status of Direct Access in your state. We recommend calling both the therapy clinic and your insurance to ask if they require a prescription.

Hospital-Based Physical Therapy Clinic

You might be surprised to find out that hospital-based therapy clinics are reimbursed at different rates than stand alone private therapy clinics. Hospital-based clinics often have higher costs BUT this isn’t always the case. It’s important to call and ask for their fees.

Depending on your insurance plan, a larger percentage of those costs may be covered. There is a new law that came into effect on January 1st, 2021 that requires all hospitals to display their fees so that consumers can know. You can learn more about it here: Hospital Price Transparency.

Helpful Tips to Decrease the Cost of Physical Therapy

We understand that healthcare has gotten expensive. Healthcare costs are growing at 4.6% year-to-year which far exceeds the growth rate of salaries and yearly income. Physical Therapy can already save you money compared to other options, but here are some helpful tips to even further decrease the costs:

Home Exercise Program

You should absolutely be given a home exercise program that compliments your in-person treatment. This will likely consist of stretches, strengthening exercises, and movements to help speed up the recovery. It is imperative that you do this home program as your therapist prescribes. If you aren’t given a home program ask your therapist if they can give you things to work on at home. If they don’t give you anything for home then you need to get a new physical therapist immediately.

The single best predictor of a positive outcome in physical therapy is compliance with a home exercise program.

You might be able to save costs by going into the clinic less frequently if you do your exercises at home more. You will recover faster by needing less total visits to get back to normal depending on your home efforts.

Don’t Wait and See – Go to Physical Therapy Early

I know it’s tempting to want to wait and see if your injury will get better on your own. If you aren’t noticing improvement or your symptoms are getting worse after 2 weeks then try and get into physical therapy as soon as you can.

There is solid evidence that the sooner you get into physical therapy the faster you will recover, the cost is lowered, and there is nearly a 50% reduction in getting an MRI if you can get into physical therapy within 4 weeks.

Go to Physical Therapy before getting an MRI

I know it’s tempting to want to “know” what’s going on before going to physical therapy but this isn’t the best option for a reason:

Your therapist likely has a Doctorate degree and will be able to give you an accurate diagnosis
You have to wait to get the MRI and time is valuable. You could be already on your way to healing with PT
You are 34% more likely to have surgery simply by getting an MRI

Ask if the Treatment is Evidence-Based

It’s important to receive the most up to date care to recover faster. To ensure that you get the most advanced care, ask your therapist if the treatment is evidenced based. A few other ways to make sure that you are getting the most up-to-date care is:

Avoid passive treatment modalities such therapeutic ultrasound, e-stim, and iontophoresis where long term evidence is lacking.
Seek our therapists with a physical therapy specialization such as an OCS, SCS, NCS, or GCS.
Seek out therapists with a Doctorate in Physical Therapy or a Transitional Doctorate in Physical Therapy

Ask for a Cash Discount

Most clinics will offer a cash discount that is 20-30% less than normal prices. Plus, it takes out some of the hassles of getting pre-authorized with insurance. Remember, until you meet your deductible you are a cash patient already.

Some savvy patients will pay cash for their whole physical therapy treatment and then ask for the notes and submit them to their insurance once they are done. (be sure to ask your insurance if you can get reimbursed like this before doing.)

Ask for Fewer Visits

Most of the time physical therapy will consist of 2-3 visits a week. Anything more than that is honestly overkill and does not allow the body to respond to the previous treatment. You can ask your therapist if 1-2 treatments a week, in addition to your home program, will be enough to recover at the same expected pace. This does put more responsibility on you to do your exercises but can be a way to save money.

In Review

Health care costs can be confusing and difficult to understand. It’s helpful to know the costs of other medical procedures and to compare the benefits. Physical therapy is a great option for lower cost treatment and often provides a long term solution as compared to injections or other temporary pain relieving treatments.

Works cited

https://www.toyourhealth.com/mpacms/tyh/article.php?id=1447#:~:text=When%20combined%20with%20surgical%20costs,%24112%2C000%20for%20a%20cervical%20fusion.

https://health.costhelper.com/corticosteroid-injection.html