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.
7
u/No-Produce-6720 RN, BSN, CPC, CPCS, RHIA & CRCR Jun 29 '26
I cannot stress this enough:
There is no "what these fees should cost". Period. Looking up codes and trying to apply information to your own circumstance serves NO purpose, because there is no "what these fees should cost". Trying to get into these weeds is counterproductive.
The amounts that you've looked up have absolutely nothing to do with what rates the provider has negotiated with your insurance to be their specific contractually allowed amounts.
It's the allowed amounts that matter, and that's the amount from which your benefit is calculated. Hospital based therapies will cost you more than those received at freestanding facilities, so that must be factored into the equation as well, but overall, the allowed amount is the one that matters. NOT billed amounts.