What Will My Costs Be?
Click on the button below for a printable version of this page
How to Determine Your Insurance Benefits for Physical Therapy
Call the toll free for customer service for members (not providers) on your insurance card. Select the option that allows you to speak to a customer service representative.
Ask the customer service representative to quote your physical therapy benefits. Total Motion Therapies, LLC has a National Provider Identification Number (NPI) of 1568964484. Make sure the representative identifies if the coverage is in or out of network.
Ask these questions to understand your coverage:
Do you have a deductible? Yes / No
Is there a separate in network and out of network deductible? Yes / No
How much is the deductible? _______________
How much of the deductible has already been met? __________________
Do you have a % of reimbursement and/or co-pay?
% reimbursement _____________
Does your policy require a physician referral? Yes / No
If a referral is required, must it be from your primary doctor?
Does your policy require pre-authorization or authorization after the referral or after x number of visits? ____________________________________________
How do you submit a claim to your insurance? ________________________________________________
Web/mailing address to send a claim: __________________________________________________________
What information is necessary to submit the claim?
Our receipt has the following information in addition to your name:
Date of service
Provider name and credentials
Provider name and NPI number
Charges and patient payment
Is it necessary to submit a copy of the referral with the claim? Yes / No
Is it necessary to submit a copy of the evaluation with the claim? Yes / No
Is any other information required? If yes, what is it? _______________________________________________________
Understanding this information
A deductible must be satisfied first before the insurance company will begin reimbursing for treatment. Submit all of your bills so that these amounts will be applied to pay down the deductible.
If you have an office visit co-pay and a % of coverage, the insurance company will subtract the co-pay amount first and then calculate the percentage they will pay from the remaining amount.
The reimbursement percentage your insurance will pay will be based on your insurance companies established “reasonable and customary” rates for the service codes rendered. These amounts will not necessarily match the charges for these codes.
If your policy requires a doctor referral you must obtain this from your doctor prior to starting therapy so that the date of the referral is no later than the date of the first therapy visit. Be sure to identify if the referral is required to be from your primary care physician or not.
If your policy requires preauthorization you must notify us at least 3 business days prior to your initial evaluation so this process can be completed. If an authorization is required after your evaluation or after x number of visits, you are required to inform us of this 3 days prior to the end of the authorization so we can authorize the next visit prior to that date.
This worksheet was created to assist you to better understand your coverage and plan to obtain reimbursement for your physical therapy services; please ensure all of your questions are answered and your have a full understanding of your coverage and responsibilities while speaking with the representative. This worksheet does not a guarantee of reimbursement to you. I suggest your record who your spoke with and when, obtain a reference number, and keep it for your records.
Please contact us if you have any further questions or would like help understanding your benefits.
Fees listed by CPT code for insurance billing and for discounted payment at time of service:
Charge / Charge discounted for self-pay payment at time of service
Initial evaluation (97161, 97162, 97163): $107.70/$70.00
Re-evaluation (97164) $53.85/$35.00
Mechanical Traction (97012) $53.85/$35.00
Electrical Stimulation (97014, G0283) $53.85/$35.00
Ultrasound (97035) $53.85/$35.00
Therapeutic Exercise (97110) $53.85/$35.00
Neuromuscular Re-education (97112) $53.85/$35.00
Gait Training (97116) $53.85/$35.00
Manual Therapy (97140) $53.85/$35.00
Therapeutic Activity (97530) $53.85/$35.00
Orthotic Management and Training (97760) $53.85/$35.00
TENS unit Education and Training (64550) $53.85/$35.00
Estimate cost per visit for patients that are self-pay/payment at time of service: $140.00 (A typical visit is 60-65 minutes and 4 CPT codes except for the initial visit which is typically the initial evaluation code plus 2 CPT codes)
This is a Recurring Cost per visit effective to 12/31/22. You are in control of how many visits and which services you purchase on a recurring basis.