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...
Physical Therapy Business Organizational Chart for Private Practice
Most of us start a physical therapy private practice because we believe we can deliver a better patient care experience, earn more money, and enjoy the time freedom of owning a business. Creating a physical therapy business organizational chart is the first step in...
How to Monetize a Physical Therapy YouTube Channel
How do you actually get paid doing this? Do you get a check from youtube? Do you have a certain type of account? Are there specific points (amount of subscribers, views, etc) you have to reach before you even monetize? Just curious on the logisticsFacebook Member...
CPT Code 97140 Manual Therapy
CPT Code 97140 Documentation Guidelines Medicare Part B - According to Medicare LCD L34049 "Documentation must clearly support the need for continued manual therapy treatment beyond 12-18 visits. When the patient and/or caregiver has been instructed in the performance...
Physical Therapy Business SWOT Analysis
Physical Therapy Business SWOT Analysis Strengths Weaknesses Opportunities Threats Physical Therapy Private Practice Strengths 2022 has seen some major challenges for small physical therapy private practices. Declining Medicare reimbursement Increasing Regulations...
Most COMMON Physical Therapy Billing Modifiers
5 Most Common Physical Therapy Billing Modifiers GP CQ KX GA 59 GP Physical Therapy Billing Modifier "GP = Services delivered under an outpatient physical therapy plan of care." When a physical therapist is delivering the clinical service a "GP" modifier should be...
Best Way To Attract More New Cash Pay Physical Therapy Patients
Attract More New Cash Pay Physical Therapy Patients in 2022 Okay, before you freak your freak this isn't clickbait. If you want to Attract More New Cash Pay Physical Therapy Patients in 2022 the easiest way to do it is... Become a contracted Medicare provider!Cash Pay...
Buying a Physical Therapy Practice vs Starting One
Buying a physical therapy practice vs starting one from scratch. Buying a physical therapy practice seems like a shortcut to success. You have a proven business that is earning a profit and has referral relationships in place. What could go wrong?Related Article: How...
Triple Medicare Revenue Physical Therapy Profits
Eliminate MPPR and Triple Your Physical Therapy Profits The multiple procedure payment reduction (MPPR) is the single largest reduction to your physical therapy profits and Medicare revenue. In this article I will explain how MPPR works and how you can eliminate the...
Boost Income Physical Therapy Business Profits
Physical Therapy Business Profits - Is Physical Therapy Profitable in 2022? Yes, absolutely. Physical therapy business profits can still be achieved in 2022, but not in the way it was profitable 30-years ago. The profession of physical therapy has undergone major...
Plan of Care Certification Physical Therapy
Physical Therapy Plan of Care Certification Requirements Medicare physical therapy plan of care certication requirements are the same as an occupational therapy plan of care certification and speech language pathology plan of care certification. According to CMS...