How Does Physical Therapy Billing Work?

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How Does Physical Therapy Billing Work?
If you are considering seeing a physical
therapist, its a good idea to understand how the
billing process works before you even make an
appointment. Read on to learn about physical
therapy billing and what to do if you get stuck
with the full bill.
Does Insurance Cover Physical Therapy?
Insurance coverage of physical therapy (PT)
depends on a few factors, such as your location,
insurance plan, physical therapy facility, and
the reason you are undergoing PT. If you were
injured and are seeking physical therapy to heal
from your injury, theres a good chance your
insurance plan will pay for visits. If you are in
PT to prevent injury, however, that may not be
the case. Thats because most insurance plans
cover only medically necessary physical therapy,
or PT that has been prescribed as a treatment for
a medical issue. While at each medically
necessary visit youll still be responsible for a
copay, deductible, or
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coinsurance as outlined by your plan, your
insurance should cover the bulk of the costs for
at least a certain number of physical therapy
sessions each year.
What Are Physical Therapy Billing Codes?
Physical therapists, like all doctors, use
billing codes when submitting claims to your
insurance. These codes form a kind of language
that practitioners and insurance companies share,
allowing the insurance provider to quickly sort
out whether or not your visit will be covered.
The physical therapist will need to choose a
diagnosis code to explain why your condition
necessitates therapy, as well as codes that
represent all the procedures or services they
offered.
What Happens Once a Physical Therapy Claim is
Submitted?

• If you have health insurance, your physical
  therapist will submit a claim to your insurance
  for the services provided using the physical
  therapy billing codes. Your insurance provider
  will then process the claim to determine how much
  of it is their responsibility to cover.
• Once your insurance provider has made a decision
  about the claim, they will pay the physical
  therapist, and then mail you an Explanation of
  Benefits that outlines
• the physical therapy claim and their coverage
  decision for each service. Then, the
• physical therapy office will bill you for the
  difference between the total amount and what your
  insurance company paid.
• Are you staring down a large physical therapy
  bill? See how aJust can help!
• Dealing With Denied Physical Therapy Claims
• In the event that your physical therapy claim was
  denied by your insurance, youll be receiving a
  bill for the full amount from your physical
  therapist. Your claim may be denied for a few
  reasons
• Simple Errors. A simple error in physical therapy
  billing (such as missing a digit in your
  insurance member ID) can lead to a denied claim.
  In some instances, your insurance will reject
  rather than deny a claim with errors, sending it
  back to the PT provider for more information.
• Eligibility Issues. If your health plan wasnt
  due to start for a few weeks (or you were
  otherwise ineligible for coverage on the date of
  service) but you submitted a physical therapy
  claim anyway, thats cause for a health insurance
  denial.

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• Billing Code Errors. Using outdated, incorrect,
  or not-covered diagnosis or physical therapy
  codes could result in a physical therapy claim
  denial.
• Lack of Medical Necessity. When the billing codes
  your physical therapist uses make your
• insurance doubt the medical necessity of PT in
  your situation, your claim will be denied.
• Out-of-Network Provider. Seeing a physical
  therapist who is not contracted with your
  insurance provider automatically leads to a PT
  claim denial with most plans. In some cases, your
  insurance may cover out-of-network providers,
  just at a lower rate than those in network. Check
  your plan documents or speak to your insurance
  company to figure out which is the case for you.
• When this happens, you have a few options. If the
  claim was denied due to a simple error, you can
  reach out to your physical therapists office and
  ask them to correct the error and resubmit.
• If you believe that your insurance should have
  covered the claim, you can start the appeal
  process. This is time-consuming and is a daunting
  process to take on alone, so be aware that youre
  in for a long and arduous road ahead!
• If neither of these options works, or if you
  dont have the time and energy to appeal a denied
  claim on your own, its a good idea to call a
  medical billing advocate. A medical billing
  advocate, like aJust, is a professional who can
  take over your case and swiftly discover where it
  all went wrong. Using years of experience, the
  medical billing advocate will then either take
  care of the appeal process or work on negotiating
• your physical therapy bill. In most cases, a
  medical billing advocate can either get the
  physical therapy claim covered or lower the rate
  of your bill.

Why Reach Out to aJust For Help With Physical
Therapy Claims
With aJust, you can count on communication,
transparency, and professionalism throughout the
entire physical therapy bill negotiation process.
Whether youve just received a claim denial or
you dont have insurance and need help
negotiating down your bill, aJust is there to put
their experience and expertise to good use.