September 12, 2012
Regarding the September 7, 2012, "My Turn" commentary, "Medicare charges are fishy," it is appropriate that Mr. Ourusoff thoroughly reviewed the pricing for the services and equipment he received.
These prices often bear little resemblance to the actual payments that are made. Mr. Ourusoff indicates that a unit of therapeutic exercise was $97 (two units at $194) and a manual procedure was $102. The actual cost allowed by Medicare is $30.60 for therapeutic exercise and $28.55 for manual therapy. When more than one procedure is performed on the same day, Medicare further reduces its allowed amount. In this case, the manual therapy allowed would be reduced to $25.80. Mr. Ourusoff's responsibility for these two services would typically be 20% of this allowed amount or $11.28 (20% of the combined $56.40).
The American Physical Therapy Association is precluded by law from commenting on the appropriateness of any level of pricing. However, in the discussion about health care expenditures it is critical that we look at the actual funds spent rather than prices that are not reflected in the actual payment.
Additionally, services delivered by physical therapists and physical therapist assistants under the direction of physical therapists are effective, beneficial, and recognized by Medicare and the health insurance industry as payable under their regulations and contracts.
James Nugent, Lead Insurance Relations/Private Payment Advisor
American Physical Therapy Association
Joan-Alice Taylor, PT, PsyD, President
Connecticut Physical Therapy Association
Francine Wheelock, PT, DPT, MPA, President
Maine Chapter of the American Physical Therapy Association
Deirdre Daley, PT, DPT, President
American Physical Therapy Association, New Hampshire Chapter
Wendy Baltzer-Fox, PT, DPT, GCS, WCS, President
American Physical Therapy Association, Rhode Island Chapter
Catherine Sells, PT, MS, President
Vermont Chapter of the American Physical Therapy Association