We are an out-of-network or non-participating provider. As a non-participating provider, physical therapy services are provided, and patients then pay the provider directly in full. Payment to the provider is anticipated on the same day the services are rendered.
In advance of your appointment, we recommend that you call your insurance company to be prepared for your out-of-pocket anticipated expense. Below is a guide to assist you when you are speaking with the insurance company.
Insurance procedures may vary, this is an example and should not be considered a guarantee of benefits or reimbursement.
What to do next…
- Call your health insurance member services number (typically located on the company website or the back of your insurance card) prior to your first date of service.
- Request “care coordination”, “care notification” or “notify of a procedure”.
- Please have the Graham Therapy and Fitness, P.A. information below to reference during your phone call to the insurance company:
| CPT Codes | 97163 | Physical Therapy Evaluation: High Complexity |
| 97162 | Physical Therapy Evaluation: Moderate Complexity | |
| 97161 | Physical Therapy Evaluation: Low Complexity | |
| 97164 | Physical Therapy Re-evaluation | |
| 97112 | Neuromuscular Re-education | |
| 97110 | Therapeutic Exercise | |
| 97116 | Gait Training | |
| 97140 | Manual Therapy | |
| 97530 | Therapeutic Activities | |
| Quantity of CPT codes used per day | 4-16 codes | 1 code is equal to 8-15 minutes |
| Clinic NPI # | 1285209007 |
| Location where services were given | Ambulatory Outpatient Physical Therapy Home Clinic |
| Name of the facility where you provided services | Graham Therapy and Fitness, P.A. |
| On what basis were the services performed | Outpatient |
| Type of clinician providing services | Physical Therapist |
- They may ask how many times each code may be used (see above).
- Record the date of your phone call, obtain a case reference number and person you spoke to for future reference.
- When speaking with the insurance company be specific and explain in one day, there may be 16 physical therapy CPT codes billed.
- Understand your deductible amount. For example, you may have a $6000 deductible to meet before any out of pocket expenses will be reimbursed.
Disclaimer: Health plans do change regularly without prior notification. We recommend that you verify with your health plan what physical therapy benefits you have available and also continue to monitor the insurance response throughout the course of your physical therapy care.
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