Spine & Sport Institute is Credentialed with Medicare to provide Physical Therapy. We follow all Medicare guidelines, including their Fee schedule. No Physician Referral is needed for the Initial Exam; You make an appointment, and following the evaluation and discussion on our findings, we will send our plan of care to your physician for signature. We always recommend that you call your Physician’s office to let them know of your plans to have an evaluation with us in keeping with professional courtesy. If you have an issue you believe Physical Therapy may benefit, simply call Laurie to make an appointment or to discuss how we can best meet your needs. You may also request a phone consultation with the Physical Therapist.
The basics: Medicare covers 80% of your Physical Therapy and most secondary insurances cover the remaining 20%, although some may cover less. You may want to call them to inquire. We follow the Medicare fee schedule. For example, if Medicare approved $80 for the visit, Medicare covers $64 and the remaining $16 may be fully or partly paid by your secondary; any remaining balance is your responsibility. If you do not have secondary you would owe the $16.00. (please note this is for an example only)
More than you want to know: Your Physician needs to sign our plan of care within 30 days. Medicare then considers this prescription approved for 90 days. You must meet Medicare’s determination of Medical Necessity. Medicare pays up to $2080/year once your deductible is met. If you need service over the $2080.00 and we believe you meet the “Medical Necessity” requirements, we will continue to bill Medicare with a “KX” modifier which indicates this status to Medicare. If we cannot justify Medical Necessity or your fees are above $3000, you will need to sign an ABN.