How to Determine Your Insurance Benefits for Physical Therapy 

  1. Call the 1-800 # for customer service on the back of your insurance card. Select the option that will allow you to speak with a customer service provider, not an automated system. 

  2. Ask the customer service provider to quote your physical therapy benefits in general. These are frequently termed rehab benefits and can include occupational therapy, speech therapy, and sometimes massage therapy. 

  3. Make sure the customer service provider understands you are seeing a non-preferred provider/out of network provider 

  4. If your doctor has referred you, tell the customer service provider this information. 

What YOU need to know: 

  • Do you have a deductible? If so, how much is it? How much is already met? 

  • What percentage of reimbursement do you have? (60%, 80%, 90%, are all common amounts) 

  • Does the rate of reimbursement change because you’re seeing a non-preferred provider? 

  • Does your policy cover telehealth at the same rates as in-person care?

  • Does your policy require pre-authorization, or to have a referral on file for outpatient physical therapy services?
    **Note that Washington state is a direct access state for physical therapy services, meaning you should not be required to get a written prescription. 

    • If yes, do they have one on file?

  • Is there a dollar ($) or visit limit per year? 

  • Does your policy reimburse for all common physical therapy codes used? Each code is billed at $60 per unit of 15 minutes, all follow up appointments are typically one hour or 4 units.

    • Evaluation 97161, 97162, 97161 and Re-evaluation 97164

    • Therapeutic Activity 97530

    • Neuromuscular Re-education 97112

    • Therapeutic Exercise 97110

    • Manual Therapy 97140 

  • What is the mailing address you should submit claims/ reimbursement forms to? 

  • Is there an option to submit claims/ reimbursement forms online?