insurance questions

Electric Edge Physical Therapy P.C. does not accept private insurance. However, upon request, we will provide "superbills" for you to submit to your insurance company for attempt of reimbursement through your out-of-network benefits. You understand that you are wholly responsible and liable for payment of all charges and fees assessed for services rendered. Payment may be made by credit card, cash, or check. You agree to pay any bank fees for returned checks. Beneficiaries of Medicare and Medicaid, including Medi-Cal, are not eligible to receive self-pay services per policies of the Centers for Medicare and Medicaid Services. Please contact us if you have any questions about our payment policies.

questions to ask your insurance company about reimbursement

  • Do I have out-of-network physical therapy benefits?

    • If yes, what is the out-of-network deductible? How much of that have I already met?

    • What is the rate of reimbursement for out-of-network physical therapy services?

    • What is my out-of-pocket maximum per year? Will the full cost of the PT session be reimbursed to me once my out-of-pocket maximum is met?

    • Do I have a physical therapy visit maximum per year?

  • Even if I do not have out-of-network benefits, will submitted claims contribute to my overall deductible?

  • Do I require a written prescription from a physician? Does it have to be my primary care provider or can it be another provider?

  • Does my plan require prior authorization from the insurance company before initiating treatment?

  • What does the submission process look like for reimbursement? Is it done through the mail or can it be done electronically?

  • How long does it typically take to receive the reimbursement?

  • What place of service (POS) codes does my plan accept?

  • Be sure to write down the name of the person you spoke to, day/time of call, and a reference number for your records.

Additional information that may be requested by insurance call center representative…

  • potential CPT Codes

    • initial evaluation (low complexity) - 97161

    • initial evaluation (moderate complexity) - 97162

    • re-evaluation - 97164

    • therapeutic exercise - 97110

    • neuromuscular reeducation - 97112

    • manual therapy - 97140

    • therapeutic activities - 97530

    • gait training - 97116

  • Electric Edge Physical Therapy P.C. NPI2 - 1225786387