Accurately determining healthcare costs can be extremely difficult even for industry insiders and experts. The amount of players including healthcare companies, providers, patients, and suppliers adds growing complexity to an industry that already lacks price transparency. These factors prevent patients from determining what their costs will be for healthcare utilization including Physical Therapy.
Outpatient Physical Therapy services are most often provided by private practices, healthcare organizations/systems, and physician owned physical therapy services (POPTS). One area that can significantly increase costs is a healthcare provider’s ability to bill under “incident to” billing practices. Essentially, in network Physical Therapy services are not billed by the Physical Therapist but instead billed under a physician who is able to bill a higher rate for the same service. For example, at an incident to billing site a single unit code (CPT code) of therapeutic exercise can be billed at 2-4x the rate of a private practice PT. With a typical session covering 3-4 CPT codes the costs of incident to billing can build quickly.
Two additional determinants of cost include deductibles and co pays/co insurance. A deductible is the amount of money an insurance beneficiary or patient must cover before insurance begins to pay for healthcare. Additionally, co pays/co insurances involve the costs associated with any healthcare visit regardless if deductibles have been met. When considering where to attend Physical Therapy it is critical to understand your deductible and co pay/co insurance rates included in your out of pocket costs.
Out of network Physical Therapy has recently been shown to be less expensive than in network Physical Therapy. The main reason is due to the lower number of visits required when seeing an out of network Physical Therapist. Although the price out of pocket per session will be higher the total number of visits can reduce the overall cost. Another key point is determining how many sessions I will require for my current condition. Once this number is known you can multiply it by either the cost of the session (out of network) or the co pay/co insurance and deductible (in network). In most cases, out of network Physical Therapy remains cheaper because a lower overall cost. This is one of the main reasons I left in network Physical Therapy. In short, I can get patients better with fewer visits and costs than working in an in network provider or one that bills incident to rates.
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