Medicare & Payment Options

We Accept MEDICARE PART B and SELF-PAY Patients

We are not participating providers with any commercial insurance companies. Our Medicare practice is limited to Part B and sometimes Part C. We encourage you to contact us with your insurance questions.

Services Provided Under Medicare Part B

Medicare requires that physical therapy pertain to functional goals, and requires us to speak with patients about specific goals in one of these four categories: 

 Here is a small list of functional deficits we can treat under Medicare Part B: 

If you have any difficulty in any of these categories, contact us to see how Energy Physical Therapy can help.

Self/Private Pay

We offer cash/credit payment for those that choose self/private pay. More people are choosing cash-based service due to insurance limitations and their insurance being exhausted. Other reasons people choose cash base/self pay is due to the high quality of one on one care received with Energy Physical Therapy.

Direct Access

In the state of PA you can be treated without a prescription from your physician for up to 30 days. There are some restrictions that apply. Medicare requires a prescription.

Medicare Part A

Medicare Part A treats people who are defined as homebound, typically after hospitalization from an acute exasperation cardiac, lung or diabetic problem. To be homebound means that your condition keeps you from leaving your home. Typically, home health agencies, acute hospitals, retirement/continuous care bills via Medicare Part A.

Energy Physical Therapy cannot bill under Medicare Part A. 

Medicare Part B

Medicare Part B guidelines state that private practices like Energy Physical Therapy, LLC, can treat patients who are not classified as homebound in the privacy of their home.  Outpatient clinics, retirement homes, and private practices such as Energy Physical Therapy LLC, can bill under Medicare Part B.

NOTE: Patients CANNOT be seen for Medicare Part A and Part B at the same time. This includes services such as nurses, home health aides, etc.

If you are currently receiving services that are being billed under Medicare Part A, we will be happy to treat you once those services end. We can set up an initial evaluation for services under Medicare Part B the very next day following your discharge from any services being provided Medicare Part A.

Medicare Limits on Therapy Services

Medicare Part A and B are run by the Federal Government. Patients can see any physician credentialed with Medicare. Part B is usually an 80/20 plan. That means Medicare pays 80% and 20% is left for patients or their supplemental/secondary insurance to pick up the rest.

For 2013, there is $1,900 cap for physical and speech therapy combined. After your 10^th visit, your physical therapist will re-evaluate your need for more therapy. Your therapist will let you know if you qualify for an exception for the $1,900 physical therapy cap. Some examples of medically necessary exceptions are patients with surgery such as total hip/knee/shoulder or spine surgery, fall risk, Parkinson’s, and Alzheimer’s.

UPDATE AS OF FEBRUARY 11TH, 2018

1. The therapy cap has been repealed.

2. The 2018 therapy cap for physical therapy is $2,010. Physical, occupational and speech therapy services can be rendered above this threshold and will be paid by Medicare if a KX modifier is included on the claim. Physical therapy is still combined with occupational therapy.

3. The medical manual review threshold has been lowered from $3,700 to $3,000. Services rendered above the $3,000 threshold may trigger a manual medical review for providers who are flagged for meeting certain indicators such as high denial rates and billing outliers in comparison to their colleagues. 

Medicare Part C

Also known as "Medicare Advantage or Replacement Plans", Medicare Part C is run by commercial insurance companies/private companies. Medicare Part C may have additional coverage such as vision or dental programs. It may have added overall costs such as premiums, deductibles, co-pays, coinsurance, and out-of-pocket amounts. Patients can only see physicians that specifically credentialed with that plan, like an HMO.