How much does Medicare Part B pay for physical therapy?
Average reimbursement for physical therapy visit s under Medicare part B will pay between $97 and $105 for a 60-minute, 4-unit physical therapy treatment.
The initial evaluation visit typically reimburses at a higher rate of $130 to $160 on average due to the higher relative value of the initial evaluation code.
How much does a physical therapy evaluation cost?
Medicare Part B reimbursement rates vary based on location, but in general, reimbursement rates for a physical therapy initial evaluation (CPT Code 97161, 97162, 97163) range between $90 and $110.
What determines Medicare Part B Reimbursement rates for Physical Therapy?
1.) Location –
Different states have different reimbursement rates. Watch the video at the bottom of this article to learn how you can check reimbursement rates specific to your state.
2.) Services Delivered –
Different CPT Procedure codes will reimburse at different rates. Therapeutic activity 97530 reimburses at nearly 20% higher rates than Therapeutic exercise 97110.
3.) Length of treatment –
Many of the main physical therapy codes are time based codes. The longer you treat a Medicare beneficiary the greater number of units billed and as a result the higher reimbursement per visit.
Does Outpatient Physical Therapy Pay Differently When Delivered In the Home?
No, there is no different between Medicare Part B reimbursement rates for physical therapy service delivered in the patient’s home or in a private practice clinic.
How do I Become a Contracted Medicare provider?
If you would like to learn more about contracting with Medicare as a physical therapist in private practice read this post: Click here
If you want to learn how to look up the Medicare CMS Physician Fee Schedule for 2020 and specifically for physical therapy, occupational therapy, or speech language pathology, WATCH THIS VIDEO.
In 2020 CMS Physician Fee Schedule Lookup Tool Shows:
- 97161 – $84.17
- 97110 – $30.21
- 97124 – $28.53
- 97140 – $27.83
- 97530 – $38.43
Video Time Stamps
Anthony Maritato, PT
Private Practice Owner / Physical Therapist
After starting a private practice physical therapy clinic in 2022 with his wife Kathy Maritato, PT, Tony and Kathy grew their practice to five locations across two states.
Now, Tony and Kathy enjoy spending time treating patients in the morning, coaching therapists in the evening, and being home to play with their dog Tucker and 4 boys.
More Lessons...
9 Best Physician Marketing Strategies for a Mobile Physical Therapy Practice in 2022
Best Physician Marketing Strategies for Physical Therapists As a mobile physical therapist in private practice, you have two major obstacles to overcome. Nobody knows that you exist. Most people will assume you are a Medicare Part A home health company. Developing...
9 Ways To Keep Physical Therapy Patients Motivated
What exactly is 'physical therapy motivation' and how can it help improve patient compliance and outcomes? First, let's define motivation: mo·ti·va·tion /ˌmōdəˈvāSH(ə)n/ noun 1. the reason or reasons one has for acting or behaving in a particular way. "escape can be a...
How to Contract with Anthem BCBS Physical Therapist
Why Should a Physical Therapist in Private Practice Contract with Anthem BCBS I am a physical therapist and private practice owner. My physical therapy practice, Total Therapy Solutions LLC has been a contracted provider with Anthem BCBS here in Ohio since 2006....
2022 Medicare Site Visit for New Physical Therapy Private Practice
Medicare Site Visit Checklist for Physical Therapists in Private Practice: Signage Hours of Operation Confirmation that you are open for business. Confirm that you are treating patients at the clinic. I have completed over 200 Medicare provider enrollments and over...
Add a Pickleball Program to GROW Your Physical Therapy Business
Why Add a Pickleball Program to your Physical Therapy Practice? Pickleball is blowing up in popularity. The APTA recently published an article on the topic and large national fitness clubs are adding pickleball courts faster than tennis or other sport courts. Physical...
What is Medicare MPPR Reason Code 59
The Medicare Multiple Procedure Payment Reduction (MPPR) is a reimbursement reduction that applies when to billable services when multiple services are furnished by the same provider to the same patient in the same session on the same day. How does Medicare MPPR...
How to bill a Medicare Supplemental Insurance
In this article we will discuss how to bill a medicare supplemental insurance as well as how to know when Medicare auto-forwarded your claim information to the secondary insurance plan.Bill a Medicare Supplmental Insurance for Physical Therapy Service Step 1 - Initial...
How to Deactivate a Medicare Provider Enrollment Using PECOS
"How do I deactivate a Medicare provider enrollment using PECOS?" If you are a contracted Medicare provider seeking to deactivate your contract simply follow these steps.Step 1 - Log into your PECOS account. Once you have logged into your pecos account you will go to...
CPT Code 29581 Lymphedema Billing
Reference links: Billing and Coding: Lymphedema Decongestive Treatment Article ID: A52959, A53287 CPT Code 29581 - Definition CPT Code 29581 - Application of multi-layer compression system; leg (below knee), including ankle and foot [1]Examples of graduated,...
Physical Therapy Neck Disability Index
Neck Disability Index - Functional Outcome Measure CMS Medicare Benefit Policy Manual Chapter 15 specifies that PT, OT, SLP are required to use: "Functional assessment scores (and comparisons to prior assessmentscores) from tests and measurements validated in the...