Rate Structure
Price Structure Explanation
Our price structure changed on April 1, 2021 to conform to the familiar billing systems seen from your doctor and dentist, and is the same one we use to file insurance claims for patients. Due to the complexity of the rate structure, charges are determined by the modalities performed or conducted during a course of treatment and number of timed units any modality is applied.
Modalities or procedures differ in procedure code, and rates for the various procedure codes differ from one another. Therefore, rates are not quite as straightforward as they once were. Instead, a high/low price range will display in our online scheduler and in confirmation emails for the service selected. Our pricing system incorporates and is based on Medicare reimbursement insurance rates. Medicare rates may change without notice.
Remedial Massage (Massage Therapy 97124), Myoskeletal Therapy (Manual Therapy 97140), Neuromuscular Retraining (Neuromuscular Education equivalent 97112), MAT Corrective Exercise (Therapeutic Exercise equivalent 97110), Electronic Muscle Stimulation (attended equivalent 97032), and MAT Corrective Activity (Therapeutic Activity equivalent 97530) are modalities and procedure codes we perform. Each procedure code has a different rate and these are based on the Medicare (CMS) reimbursement rates.
In addition to treatment procedures, we also perform New Patient Assessments (97161-97163 equivalents), Established Patient Assessments and reassessments (97164 equivalents). Assessment codes posted above are complexity and time-range based. See #5 through #9 below as examples of assessment codes charged together with timed unit codes.
Discounts apply for rates when patient self-pays in cash, debit/credit/HSA/FSA card, Apple Pay, Google Pay, or Cash App Pay.
We provide formal billing statements to patients who request them. This statement is different from the Square sales receipt patients may opt to receive by text or email at checkout. Some HSA and FSA accounts and patient-submitted claims for reimbursement by commercial insurance companies require this detailed statement.
Understanding Timed Units
We charge therapeutic procedure codes on a per unit basis. A “unit” is generally considered 15 minutes in length for simplicity. However, 15 minutes is a median reference of a range of time inclusive of 7 minutes on either side. For instance, performing 8 to 22 minutes of a procedure is 1 unit, while 23 minutes is 2 units (range 23-37 minutes), and so on. Any modality applied for less than 8 minutes becomes absorbed into one of the other modalities performed or is not charged. We bill evaluation codes by time and/or complexity rather than units.
| # of Units | Time Range (Mins) |
|---|---|
| 1 | 8-22 |
| 2 | 23-37 |
| 3 | 38-52 |
| 4 | 53-67 |
| 5 | 68-82 |
| 6 | 83-97 |
| 7 | 98-112 |
| 8 | 113-127 |
This may sound complicated. Because of the type of work we normally do, most patients are charged one or two procedures, although three or more modalities could be included in a single visit. Bundled procedure charges are slightly discounted.
Example #1: 4 units of Myoskeletal Therapy (97140) performed over an hour’s time. The patient charged for 4 units of 97140.
Example #2: 40 minutes of Myoskeletal Therapy (97140) and 20 minutes of Corrective Exercise (97110). The two modalities become “bundled” and the patient charged for 3 units of 97140 and 1 unit of 97110.
Example #3: 40 minutes of Myoskeletal Therapy (97140),15 minutes of Corrective Exercise (97110), PLUS 5 minutes of Neuromuscular Retraining (97112). Patient charged for 3 units of 97140 and 1 unit of 97110.
Example #4: 35 minutes of Myoskeletal Therapy (97140),17 minutes of Corrective Exercise (97110) PLUS 10 minutes of Neuromuscular Retraining (97112). Patient charged for 2 units of 97140, 1 unit of 97110, and 1 unit of 97112.
Example #5: New patient schedules New Patient Assessment, which ends up taking only 10 minutes. Patient then requests 30 minutes of Massage Therapy treatment at the end of the assessment. Patient charged for 3 units of 97124.
Example #6: New patient schedules New Patient Assessment, which takes up to 25 minutes. Patient requests to use remainder of the hour for 30 minutes of treatment, which turns out to be Myoskeletal Therapy. Treatment decision is straightforward. Patient charged a flat rate for 97161 and 2 units of 97140 timed code.
Example #7: New patient has New Patient Assessment which takes 50 minutes and requires a moderate level treatment decision. Patient requests a 60 minute treatment session afterwards, which therapist has time for. Treatment included 40 minutes of Myoskeletal Therapy and 20 minutes of MAT Corrective Exercise. Patient charged a flat rate for 97163-1, plus 3 units of 97140, and 1 unit of 97110.
Example #8: Returning patient, previously seen for neck pain, complaining of sore forearms after rock climbing after scheduling 60 minute Office Visit, Treatment. Established Patient Assessment performed in 3 minutes followed by 50 minutes of Myoskeletal Therapy. Patient not charged for the assessment (took less than 5 minutes). Patient charged for 4 units of 97140.
Example #9: Returning patient previously seen for pelvic obliquity complains of snapping sensation in their left hand after accidently hitting it with a hammer three days ago and scheduled Office Visit, Treatment for 60 minutes. Established patient assessment (97164-1) took 5 minutes and Myoskeletal Therapy performed for 25 minutes. Patient charged base rate for the 97164-1 assessment and 2 units of 97140.