Insurance – Superior Physical Therapy

What we charge the insurance company based on the
procedure code that we use

Here are the 3 main payers that we bill out with the procedure codes, the charge amount, and the allowed amount by each insurance. The description of each codes is listed below.

Medicare

Procedure Code Charged Allowed Amount
97160 $150.00 $78.03
97161 $150.00 $78.03
97162 $150.00 $79.62
97163 $150.00 $79.62
97164 $75.00 $53.50
97110 $90.00 $24.29
97112 $90.00 $33.04
97140 $90.00 $22.55
97530 $65.00 $33.97

BCBS

Procedure Code Charged Allowed Amount
97161 $150.00 $76.15
97162 $150.00 $79.62
97163 $150.00 $79.62
97164 $75.00 $51.77
97110 $75.00 $53.50
97112 $90.00 $30.39
97112 $90.00 $31.73
97140 $90.00 $28.06
97530 $65.00 $32.73

The definition of what each code means as it relates to the treatment we performed

97140
Manual Therapy Techniques (mobilization, manual traction )
97530
Therapeutic activities; Direct one-on-one patient contact, use of dynamic contact, use of dynamic activities to improve funtional performance.
97112
Therapeutic procedures, 1 or more areas neuromuscular, re-education of movement, balance, coordination, kinesthetic sense, posture and or proprioception, for sitting and standing activities.
97110
Therapeutic procedures, 1 or more areas neuromuscular, re-education of movement, balance, coordination, kinesthetic sense, posture and or proprioception, for sitting and standing activities.
97162 | 97163 | 97164
Evaluation of injury / issue

Priority Health

  • Is a flat Reimbursement the first visit (evaluation visit) 90 + 75 = $165.00
  • All visit after that ia not an evaluation is a flat $75.00 per visit
  • Allows $90.00 for all evaluations and $75.00 per day for treatment

Take out the Priority Health blipEver wonder what all the cost of health care? Here are some quick definitions and examples

PREMIUM

A premium is the amount of charged by your Insurance company for the plan you chose. You typically pay monthly for this. You must pay your premium to keep your coverage active.

Here is an example….

You have researched health plans and rates and you have chosen one for $150.00 per month. In order to keep your benefits active, you will need to pay your premium on time every month.

DEDUCTIBLE

A deductible is a set amount you must pay every year toward your medical bills before your Insurance company starts paying. It varies by plan and some plans do not have a deductible.

Here is an example….

Your plan has a $1,000 deductible. That means you pay your own medical bills up to $1,000 for the year then your insurance coverage kicks in. At the beginning of each year you must meet the deductible again.

COINSURANCE

Coins is the percentage of your medical bill you share with your insurance company after you have paid your deductible.

Here is an example….

You have an “80/20” plan. That means your insurance company pays for 80 percent of your cost after you have met your deductible. You pay the for 20 %. Coinsurance is different and separate from any copayment.

COPAYMENT OR COPAY

Your copayment or copay is a flat fee you pay every time you go to the doctor or fill a prescription. It usually a relatively small dollar amount. Copays do not count towards your deductible.

Here is an example….

Let’s say your plan has a $20.00 copayment for a Physical Therapy treatment. That means you must pay $20.00 each time you go. Copayments are different than coinsurance.

Helpful hints…

  • The higher your deductible the lower your premium.
  • Certain insurance companies have a Physical Therapy visit limit.
  • Physical Therapy is normally a COMBINED benefit with Chiropractic and Speech Therapy.
  • If you are enrolled in home healthcare your insurance will not pay for out patient Physical Therapy treatment until you are discharged.

Contact Us

Office Hours:
7am - 7pm Monday to Friday

Superior Physical Therapy (West)
3899 West Front St.,
Traverse City, MI 49684
phone: 231.944.6541
fax: 18662055924

Superior Physical Therapy & Spine Center (Central)
722 Munson Ave, Traverse City, MI 49686
phone: 231.421.9300
fax: 231.346.6079

Superior Billing Office
3899 West Front St., Traverse City, MI 49686
phone: 231.421.9277
fax: 231.346.6117