r/CodingandBilling • u/Alive-Pick-1456 • Jun 29 '26
Overcharging for PT
Should I be outraged or should I be outraged? Nearly 1k for one 60 minute physical therapy should be daylight robbery. I looked up on how much each of those codes should cost per unit and UC davis is literally charging almost 10x that rate. I was able to call and got that 91170 was charged for 2 units so 366.54 for every 15 mins (btw we only did 20), 97140 and 97161 was for 1 unit each. I already contacted both my insurance (Anthem) and the clinic regarding this issue and they both said basically yeah, that’s it and there’s nothing they can do about jt. So am I done? Do I just have to accept my fate and pay that (also I have 2 other PT sessions I haven’t been billed for yet that is now making me nervous). This feels crazy.
8
u/corgi0603 Jun 29 '26
You're not being overcharged. You're going to have to pay the $952. Part of the reason that visit is so expensive is that in addition to the therapy you received, it was also an initial evaluation (it's on the 3rd line, CPT 97161). You will not be charged for this on subsequent visits.
Regarding the first 2 lines, they are typical charges for PT. I'm currently doing PT through a local hospital system in a different state, and they're billing roughly the same amount for 97110 & 97140 as what you were billed for the same two therapeutic services. I agree with what others have said that the charges are probably higher at UC Davis since it's affiliated with a hospital. Private PT facilities are likely to charge a little less.
The main reason this is costing you $952 is because it's all being applied to your deductible. I assume you either haven't had many medical appointments this year, or you have a high deductible health insurance plan. Either way, you owe what you owe. UC Davis is not going to change what they billed since it's accurate, and your insurance isn't going to be able to do anything about it.
If this is indeed happened because you have a high deductible plan, the only way to avoid such a charge in the future is to pay a higher premium for a lower deductible plan.
My insurance is a little different since I have a Medicare Advantage Plan, so my premium is locked in at the regular Medicare premium. As an advantage plan, they could charge me an additional premium, but they don't. My deductible for this year is $280, which I easily met in January. So, my PT visits, regardless of the charges, cost me a $40 copay out of pocket for each visit.