Do physical therapists make house calls?

1.) Do physical therapists make house calls?

Yes! Physical therapists provide in home physical therapy after surgeries or when patients are unable to attend outpatient physical therapy at a clinic.

There are 2 types of in home physical therapy:

1. Home health physical therapy
2. Outpatient physical therapy in the home

The first is called “home health” and it requires patients to be homebound. It also requires the patient to need nursing services.

The second is called “outpatient in the home” and it does not have the same homebound or nursing requirement.

Outpatient physical therapy in the home offers all of the same great value of traditional outpatient physical therapy a patient may receive in the clinic with the added benefits of convenience, flexibility, and practice application to your home environment.

2.) How much does in home physical therapy cost?

Outpatient physical therapy in the home is often covered by insurance and billed at a national average rate of $50 per 15 minutes. 

Prices for in home physical therapy often vary by state, city or rural, specialty services, and other factors. Here in Ohio, Medicare Part B allowed amounts for physical therapy as of 2022 are listed in the table below:

97161 – Physical Therapy Initial Evaluation –  $98.60

97110 – Therapeutic Exercise – $28.97

3.) Can outpatient therapy be provided in the home, office, or my fitness center?

If you choose an out of network provider you have the flexibility and freedom to choose when and WHERE you receive these services. Patients may have a physical therapist to provide services at the patient’s office, in a local park or fitness center, or even at the local grocery store.

In-network therapists are more limited. Medicare for example will only cover outpatient services in the patient’s home or in a clinic.

4.) What does a home health physical therapist do that is different than outpatient in the home?

Traditional home health physical therapy services most often include nursing care, occupational therapy, and sometimes speech language pathology. A home health treatment plan is often focused on gaining independence and safety for a homebound individual.

Outpatient physical therapy in the home does not require the patient to need nursing care nor does it require the patient to be homebound. Outpatient physical therapy in the home focuses on returning a patient to prior levels of function and performance. An outpatient therapist may also be hired on a self pay basis to provide additional services not covered by insurance.

Additional outpatient therapy services not covered by insurance include:

• Dry Needling
• Golf Performance
• Return to Sports
• Gardening
• Community Activities in the Community (e.g. trips to the grocery, salon, sporting events.)

5.) Should I tip my physical therapist?

No. It is not customary to tip a physical therapist.

6.) Will Medicare pay for in-home physical therapy?

Yes, Medicare part A pays for traditional home health physical therapy.

Medicare part B pays for outpatient physical therapy in the home.

Medicare part C is the Medicare advantage program and it is recommended that patients contact their insurance provider to determine coverage.

7.) How many days will Medicare pay for physical therapy?

Currently, Medicare part B pays for covered physical therapy service delivered in your home or in a clinic as long as the services are determined to be medically necessary and reasonable. Outpatient physical therapy is not counted by number of days. 

Medicare part B does have a financial threshold of $2,110/year for physical therapy and speech language pathology services and a separate threshold of $2,110/year for occupational therapy services.[1] The threshold simply means that if continued services beyond that dollar amount remains medically necessary and reasonable your therapist must indicate so on the claim.

8.) What is the maximum number of house calls Medicare will cover?

Medicare does not place a limit on the number of house calls a physical therapist may perform. The decision of payment is based on medical necessity. 

9.) How many times a week should you go to physical therapy?

This number will vary based on your specific condition. Some patients may receive as few as 1 physical therapy treatment to learn a home exercise and learn about their condition while others may require physical therapy 5 days a week for several weeks.

10.) When should I stop physical therapy?

You and your therapist will determine an appropriate course of care. You are always able to stop therapy at any time. You and your therapist will create a plan of care which includes your personal recovery goals, an expected length of time to achieve those goals, and a frequency of sessions per week.

If at any point something changes and you wish to stop therapy simply notify your treating therapist and a discharge will be performed.

11.) How many physical therapy sessions does insurance cover?

Each insurance plan and policy may vary widely on the total number of sessions covered. Medicare does not have a visit limit but requires your care to be medically necessary. 

Some non-Medicare plans may limit the annual number of covered visits regardless of condition. 

Others still may limit the number of visits based on your condition.

It is important that you know what your coverage policy is and how it will work.

If you are privately paying for services, the decision is solely up to you and your therapist.

12.) How long should physical therapy last?

Each session’s duration may last from 15 to 60 to 90-minutes.

Your condition may only require a single unit of manual therapy for 15-minutes or a more comprehensive, multisystem treatment taking 90-minutes.

13.) What is a cash based physical therapy practice?

“Cash based physical therapy” is another term of self pay, direct pay, or insurance that is paid for directly by you the patient without going through insurance.

The benefits of cash based physical therapy includes your freedom to receive a more holistic patient care experience.

Insurance does not pay for everything. Even services you and your therapist may believe are beneficial. In a cash based physical therapy system you are able to work directly with your therapist to create a comprehensive plan of care without a third party payer telling you what services you are allowed to receive.

14.) What is Mobile PT?

“Mobile PT” is a term used to describe outpatient physical therapists who provide services in your home, office, fitness center, or location of your choosing. A Mobile PT may accept insurance or may offer self pay services.

You may hire a Mobile PT, Mobile OT, or Mobile SLP.

Some mobile providers also offer patients out of network claim submission. If your insurance plan includes out of network coverage you may be eligible for some or all of your visit to be reimbursed.

15.) Do I need a referral for physical therapy under Medicare?

No, under Medicare part B guidelines, a referral is not required but is recommended. Medicare part B does however require you the patient to be under the care of a physician or non-physician practitioner and that individual must sign (certify) a therapist’s plan of care in order for those services to be eligible for reimbursement. [2]

No, a referral or prescription is not needed to start physical therapy.

Cited References: 

[1] – 2021 Annual Update of Per-Beneficiary Threshold Amounts

[2] – https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf