Your health, time, and money are three of your most valuable resources, but money can be a huge influence on the other two. Investing in yourself is one of the best decisions you can make, but it can get expensive, especially if you need physical therapy. There are many people who live with daily chronic pain because they cannot afford the means by which they can feel better, and the pain causes stress not only on their physical health, but also on their mental health.
At EW Motion Therapy, we understand that cost is an important question because we hear it multiple times a day at our clinics. In the 20+ years of serving our community, we have become well equipped to understand the costs for our physical therapy services. Understanding a few key concepts surrounding how you are charged will guide you in making the best healthcare and budgetary decisions.
Pricing for physical therapy depends on three factors:
Understanding these factors will help you make more sense of your bill and give you confidence as you plan out your budget.
What is done in your visit
The national average per session cost of physical therapy can range from $30 - $400. However, with a qualified insurance plan, once your deductible is met, your total out-of-pocket cost typically ranges from $20-$60. If you do not have insurance, you may be paying between $50-$155 out-of-pocket. This price range is extensive, and one of the factors that influences that range is the type of procedures done in each visit you have with your therapist.
The Cost Of An Initial Evaluation/Treatment (IE)
Your therapist will perform an IE during your first visit. They will go over your medical history, do a full-body evaluation, create a care plan (including future goals), begin treatment, teach you more about your condition, and prescribe a home education/exercise program. Since an IE is more in-depth than a daily visit, it may cost more.
Your care plan determines how often you see your therapist and how long your treatment will last. Depending on your needs, you may have up to 3 appointments or more per week. Typically, an IE lasts 30 to 90 minutes (about one and a half hours).
- The national average range of an evaluation cost: $50 - $400
- With insurance, average per session, out-of-pocket expense (with deductible met): $20-$60
- National average out-of-pocket expense without insurance: $50-$150
- EW Motion Therapy’s cost range: $55-$220
The Cost Of Daily Visits
Daily visits involve meeting with your therapist to evaluate and progress your care plan. Treatment frequencies follow the guidelines established in the IE and often decrease as you make progress.
A daily visit typically has a lower cost than an IE because therapists can only charge for an IE once. Treatment sessions usually range between 30 to 90 minutes.
- National average cost of a daily visit: $20-150
- With insurance, average per session, out-of-pocket expense (with deductible met): $20-$60
- National average out-of-pocket expense without insurance: $50-$155
- EW Motion Therapy’s average cost: $40-$155
- EW Motion Therapy’s average out-of-pocket expense with insurance: $0-$60
- EW Motion Therapy’s average out-of-pocket expense without insurance: $55-$155
Wanting to try physical therapy for yourself? Click to download 20 Physical Therapy Questions, Answered to learn more.
How the therapist bills your visit
Why are some physical therapy facilities more expensive than others?
There is no one standard way for therapists to bill clients, and the cost of your visit depends on a few factors. How a therapist bills your visit should depend on how much time a therapist spends with a client, the treatment interventions he uses, and coding classification guidelines.
All of these can vary between treatments, clinics, and therapists.
CPT codes
Physical therapists charge for treatment performed with CPT codes (Current Procedural Terminology), as published by the American Medical Association (AMA). Therapists use these codes to charge for an evaluation and classify different treatment interventions. Therapists will bill codes following established guidelines set forth by the AMA and/or CMS (Centers for Medicare & Medicaid Services).
Treatment interventions
Physical therapists utilize interventions to help clients achieve goals. Examples of interventions may include stretching a problem area, doing extra exercises during an appointment, and different procedures such as electrical stimulation, dry needling, and ultrasounds.
Your therapist will use their professional judgment in deciding whether to use an intervention to progress your rehabilitation. Interventions may change from session to session based on the client’s needs at that point in time.
Billable time
For most interventions, you are charged based on time. A skilled, billable intervention(s) should be administered by a licensed physical therapist (LPT) or licensed physical therapist assistant (LPTA). Depending on insurance type, practitioners will follow either the CMS or AMA guidelines for billing. Your session time and the number of allowable, billed treatment interventions will determine the cost.
What does insurance cover when it comes to physical therapy?
When choosing a clinic, it is essential to know which insurance plans they accept and how much your copay or out-of-pocket cost will be. If you do not have health insurance, you will have to pay for all of your treatment out-of-pocket, so keep that fact and your budget in mind.
When considering how insurance will affect your cost, there are three things you need to think about:
- Your insurance plan
- Your deductible
- Your copay
Your insurance plan
In most cases, insurance plans lower your out-of-pocket cost. Health insurance will typically cover 50-80% of the cost of necessary medical services. Also, some insurance companies work out a reduced fee schedule with “in-network "providers.
Your specific plan will cover allowed amounts for different services. You will have to pay co-payments (co-pays) out-of-pocket at some visits, and there is a deductible amount you have to spend before the insurance company covers anything. Each of these can factor into your out-of-pocket costs.
Your deductible
Most plans require you to reach a deductible amount before covering services. Plans with high deductible amounts will increase your cost as you will be paying out-of-pocket until you meet your deductible.
Often, clients with high deductibles may have secondary insurance that covers some or all of their deductible. Those with a high deductible, or those without insurance, may also choose a self-pay option if it is cheaper to pay out-of-pocket.
The average range of insurance deductibles is $100 -$7000+.
Your co-pay
Insurance plans typically require a co-pay, an out-of-pocket fee. After meeting your deductible amount, you will pay a co-pay for each visit. It is always a great idea to review your policy amount before treatment.
Co-pays are a percentage of an allowable amount, typically 20-30% of the sessions' cost. If your plan does not have a deductible, you will be required to pay a co-pay for each visit.
- National average cost of co-pays: $20-$60
- National average out-of-pocket expense without insurance: $50-$150
- EW Motion Therapy’s average co-pay: $10-$60
- EW Motion Therapy’s out-of-pocket expense without insurance: $55-$155
Navigating varied costs and insurance coverage
We hope this article has helped you consider the many factors that influence the cost of your treatment. Understanding how health insurance affects your treatment cost can be difficult, and if you would like more information, feel free to read our article on health insurance as it relates to physical therapy.
At EW Motion Therapy, we are so grateful for the trust our clients have placed in us over the past 20+ years, and we are eager to assist you on your health journey. If you would like more information on how to determine the cost of your treatment, watch our physical therapy pricing guide video for details.
