Top 10 Highest Reimbursing Medicare Localities for Physical & Occupational Therapy Practices

Author: Paul Singh

As a physical therapy billing and software company that works with both new and established practice owners in the physical/occupational therapy industry, we are often questioned as to what areas of our great nation have the highest reimbursement. Our social media walls are often filled with articles that advertise the “Top 10 beach resorts in the U.S.” or “The Top 10 restaurants in Orlando” so we decided to dig into the 2017 Medicare fee schedule to create a top 10 list of the highest reimbursing Medicare localities for outpatient physical & occupational therapy practices. So what’s your guess?

If you take a look at a few of the most common billing codes for outpatient physical/occupational therapy, the #1 locality based solely on the Medicare fee schedule goes to Alaska! Yes, the chilly mountains of Alaska not only come with breathtaking views but extremely well priced Medicare reimbursement for outpatient physical/occupational therapy services. One very important note to make is that these reimbursement values are based on billing a single code and not multiple codes that would result in the application of the physical therapy MPPR.

Top 10 Localities for A Physical Therapy Eval, 97162

Top 10 Localities for a Unit of Therex, 97110

TABLE OF TOP 10 Localities for a unit of Therex, 97110

Let’s Check Out an Example

Patient John Smith comes into your Anchorage, Alaska Physical Therapy Clinic and you treat him for 1 unit of 97162 (evaluation), 1 unit of 97110 (Therex), and 1 unit of 97140 (Manual). You complete your documentation and the magic of StrataPT’s physical therapy billing happens behind the scenes and 15 days later you have a deposit into your account of $135.04 (80% of the Medicare allowed of $168.80 with remaining 20% covered by secondary or patient)

Now, let’s say you transported to Jackson, Mississippi and treated John Smith for the same combination of codes, your reimbursement deposited into your bank account would be $95.10 (80% of the Medicare allowed of $118.88 with remaining 20% covered by secondary or patient)

That’s an incredible variance for just a single date of service – $49.92! As you can imagine, over the course of the year and with several thousand visits, this could significantly add up!

So how does your locality compare to other parts of the country? Feel free to play with our 2017 Medicare Calculator to see how your locality compares at a national level.

Physical & Occupational Therapy Medicare Reimbursement Calculator

Most importantly, these reimbursements are only as good as the team you have working with you. You could send claims to Medicare all day and if it is not done correctly or followed up on properly, your locality doesn’t mean a thing.

Our goal at StrataPT is to collect every single penny owed to our clients while providing exceptional customer service.

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