Is Physical Therapy Covered By Insurance?

Physical therapy (PT) might be covered by your insurance plan, either partly or in full. However, your insurance will need your healthcare provider to confirm that PT is medically necessary before they will pay. 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 PT, the costs of physical therapy can still add up because of your co-pays. If you only have partial coverage, 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 insurance coverage and out-of-pocket costs for physical therapy.

Questions to Ask Your Insurance Company

Talk to your insurance company to ask about coverage before you schedule appointments and start PT. The insurance company can help you determine how much you will likely end up paying for each PT session and what requirements there may be in order for the sessions to be covered.

Is Physical Therapy Covered as Part of My Plan?

First, you'll want to check if your insurance plan actually covers physically therapy and if so, what expenses you'll be responsible for.

If it isn't covered, you'll pay the rate your insurer set with the physical therapist.

If you do have coverage, ask whether you are responsible for 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 therapy session. However, some co-payments can be as high as $50 or $75.

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 a secondary insurance, check if the secondary insurance will cover all or a portion of the remaining bill.

Is a Referral Needed?

For coverage to kick in you may need a referral from a medical provider stating that the PT is medically necessary and in some cases certain tests, such as imaging as part of a diagnosis, may be needed.

Are there Limits on the Coverage ?

If your insurance covers physical therapy, ask if there are limits on the coverage. For example, sometimes there is a limit on the number of appointments per year or per condition that are 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?

Check directly with your insurance to find out if you need to stay in-network. 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 select 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 this would be covered.

Questions to Ask Your Physical Therapist

After you contacted the insurance about coverage, requirements, and limits, you'll then want to check with the physical therapist to get a more thorough 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 various treatments performed.

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

What Are the Costs Without Insurance Coverage?

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

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

Once you have a copy of the fee schedule, talk to your therapist to make sure you understand which services will be offered and billed. Then, you can decide if the treatment plan is within your means financially.

For example, if your therapist is planning to perform 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.

Factors That Affect PT Cost

There are a few factors that can affect how much PT 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.

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 $250 to $350 if uninsured.

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

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 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 not cover equipment for PT. If your PT recommends you purchase any of these items, ask them to recommend affordable options.

Keep in mind that you don't 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 PT 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 PT, 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)
• Ask your PT clinic or provider if they offer lower prices for services if you pay in cash (sometimes called "self-pay")
• Reach 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 services, 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.

A Word From Verywell

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.