Guides
Physical therapy bundles and pricing tiers
Physical therapy services and packages guide: what a service line consists of, six line types compared by payer and slot type, and when to add or drop one.
What to take away
- Physical therapy bundles and pricing tiers are separate decisions. The bundle is the set of slots you sell together; the tier is what you charge for them. Insurance bundles collect allowed amounts, cash bundles collect your own price.
- A service line is five partsthe buyer, the payer, the slot, the episode, and the record. Change one part and you have a different line.
- The pillar split is plan-of-care work, where a payer or a referrer defines the episode, against self-pay packages, where you define it. They fill the calendar differently and carry different rules.
- Cash tiers move with commitment. A single follow-up visit commonly runs $75 to $150, an evaluation $100 to $250, and a 6-visit package typically sells 10 to 20 percent below the per-visit rate. Medicare's KX modifier threshold was $2,330 in 2024; the figure is reset each year, and for CY 2026 it is $2,480 for PT and SLP services combined.
- No service line is profitable in the abstract. It earns what a slot-hour of therapist time collects after documentation and no-shows, and that is a calculation you do with your own numbers.
- Three authorities split the decisionscope, payment and advertising. The section on treatment and wellness names them and the questions to put to each.
A service line is a slot type
The calendar holds a fixed number of therapist hours. Every line you offer claims some of them, in slots of a set length, delivered by a person with a set credential.
An evaluation is one slot type. A follow-up treatment is another. A cash-pay performance session, a group class, a home visit and a telehealth check-in are each another.
The first question about any line is which slots it takes, from whom, and what that slot collects compared with what it would have collected anyway.
The Bureau of Labor Statistics on physical therapists describes the work as evaluation, planning, treatment and documentation. Every line you add has to fit inside that day.
What a line consists of
Write each line as five parts before you offer it.
Five parts of a service line
- Buyerwho decides how it is sold
- Payerwhat it collects, documents
- Slotlength, room, equipment, credential
- Episodevisits, discharge, early stop
- Recorddocumentation and charge evidence
- The buyer. A patient with a referral, a patient who found you directly, an employer, a team, a surgeon's practice. The buyer decides how the line is sold and who explains it.
- The payer. A commercial plan, a government program, the patient, an employer under contract. The payer decides what the line collects and what it must document.
- The slot. Length, frequency, the room and equipment it needs, and whether an assistant can deliver it under the supervision the state board sets or it must be a therapist's own time.
- The episode. For plan-of-care work, the number of visits and the discharge point are clinical decisions inside the payer's limits. For a self-pay package, you define the start, the end and what happens if the buyer stops early.
- The record. What is documented, where, and what evidence supports the charge. For billed work, the payer's documentation standard applies. Self-pay work still needs a record that shows what was delivered, because the IRS guidance on which records to keep expects a business to be able to show its income and what produced it.
A line with a blank in any of the five is not ready to sell.
Here is the same five parts filled in for a self-pay running package, written as one page the front desk can quote from:
- Buyer. A runner who booked online, no referral.
- Payer. The patient. Price taken from the cash menu and paid up front.
- Slot. 60 minutes, one therapist, treatment room, one session a week.
- Episode. Six sessions defined by our program. Unused sessions expire 90 days after purchase.
- Record. Session note, signed package agreement, payment record. Prepaid balance tracked as a liability.
Line types compared by payer, slot and price
Line types compared
| Line type | Buyer and payer | Slot type | Who can deliver | What defines the episode | Typical price or tier | The trap |
|---|---|---|---|---|---|---|
| Referred rehabilitation episode (Medicare Part B, commercial plans) | Patient, paid by insurer | Evaluation then treatment slots | Therapist; assistant where the board allows | Plan of care within payer limits | Allowed amounts often $30 to $45 per 15-minute unit; the KX modifier threshold was $2,330 in 2024 and is reset each year | Authorization gaps and documentation denials |
| Direct-access episode (self-referral, where state law allows) | Patient, paid by insurer or self | Same | Same | Plan of care, subject to the state's referral rules and the payer's | Cash version typically $100 to $250 for the evaluation, $75 to $150 per follow-up visit | Assuming the payer follows the state |
| Postoperative pathway (Medicare CJR and TEAM bundles) | Surgeon's patients, paid by the hospital bundle or insurer | Protocol-driven treatment slots | Same | The surgeon's protocol and the plan of care | The bundle pays for the episode, 90 days under CJR and 30 days under TEAM from January 1, 2026 | Dependence on one referrer |
| Self-pay post-rehab package (Ivy Rehab, ATI, FYZICAL and most chains) | Patient, paid by patient | Sessions you define, often 4 to 12 | Whoever the board allows for that activity | Your program design | Single visit $75 to $150; a 4-session block typically 10 percent off; 8 to 12 sessions typically 15 to 20 percent off | Promising outcomes you cannot evidence |
| Employer or team contract (Concentra, Fit For Work, Hinge Health, Sword Health) | Organization, paid by contract or per member per month | Blocks of hours, often off-site; digital programs use an app plus remote visits | Therapist | The contract | On-site coverage commonly $75 to $150 an hour; digital MSK contracts typically $3 to $10 per employee per month | One contract loss empties a column |
| Telehealth or remote check-in (Sword Health, Kaia Health, most clinic portals) | Patient, paid by insurer or self | Short slots, no room | Therapist, subject to the board's telehealth rules | Plan of care or program | Cash typically $40 to $90 per session | Payer coverage varies and changes |
| Assisted-stretch or wellness membership (StretchLab and similar studios) | Patient, paid by patient | 25 to 50 minute sessions, no treatment | Trained stretcher, not a therapist unless the board allows | The membership term | Typically $49 for 25 minutes and $89 for 50 minutes; memberships commonly $150 to $250 a month | Selling it as physical therapy |
| In-home visit (Luna, FOX Rehabilitation) | Patient, paid by Medicare Advantage or self | 45 to 60 minute slots at the patient's home | Therapist or assistant | Plan of care | Cash commonly $100 to $150 a visit; Medicare Advantage contracts pay per visit | Travel time that does not bill |
Read the last column first. It is the reason each line needs a written policy before it goes on the menu.
Line types: payer, slot, price
Referred rehab
- Buyer and payer
- Patient, insurer
- Slot type
- Eval then treatment
- Who can deliver
- Therapist; assistant
- Episode defined by
- Plan of care, payer limits
- The trap
- Authorization gaps, denials
Direct access
- Buyer and payer
- Patient, insurer or self
- Slot type
- Same
- Who can deliver
- Same
- Episode defined by
- Plan of care, referral rules
- The trap
- Assuming payer follows state
Postop pathway
- Buyer and payer
- Surgeon's patients, insurer
- Slot type
- Protocol-driven
- Who can deliver
- Same
- Episode defined by
- Surgeon's protocol
- The trap
- Dependence on one referrer
Self-pay
- Buyer and payer
- Patient, patient
- Slot type
- Sessions you define
- Who can deliver
- Whoever board allows
- Episode defined by
- Your program design
- The trap
- Promising unevidenced outcomes
Two things set a tier. An insurance tier moves with the allowed amount, the patient's deductible and the visit limit. A cash tier moves with your slot-hour cost and how many sessions the buyer commits to up front.
Medicare's Comprehensive Care for Joint Replacement model pays for hip and knee replacement as a 90-day episode, physical therapy included. The Transforming Episode Accountability Model starts January 1, 2026 in selected regions, with 30-day episodes that include lower extremity joint replacement.
Hinge Health, Sword Health and Kaia Health sell employer and health plan contracts instead of visits, priced per member per month. The vendors do not publish rates.
Digital MSK contracts commonly run $3 to $10 per employee per month in most markets. The package usually includes app-based exercise plus remote visits with a licensed clinician.
Cash prices move with the market. The figures below are typical, not surveyed. Rent, wages, local commercial allowed amounts and the number of competing clinics move them up or down.
Cash pricing by market
| Market | Cash evaluation, typical | Cash follow-up, typical | 6-visit package, typical |
|---|---|---|---|
| Large metro | $175 to $250 | $110 to $150 | $600 to $810 |
| Mid-size city or suburb | $125 to $175 | $90 to $125 | $460 to $675 |
| Small town or rural | $100 to $140 | $75 to $95 | $360 to $510 |
The package column applies the 10 to 20 percent discount to six visits at the follow-up price. A metro clinic with several competing practices often prices near the top of its range. A rural clinic with few competitors often prices near the bottom.
Treatment, wellness, and who decides
The line between physical therapy treatment and a wellness or performance service is not yours to draw. Three bodies draw it.
The state physical therapy board decides what counts as practice, what a licensed person may and may not do, and what an unlicensed person may do in your building. Ask it in writing before you offer anything that is not a plan-of-care episode.
The payer decides what it pays for. Medicare's coding and billing rules for therapy services are on the CMS therapy services page; commercial payers publish their own. A service the payer does not cover can usually be sold to the patient directly.
Whether you can sell it to a patient who is also in a covered episode, and how to separate it, is a contract and compliance question for a qualified adviser.
The FTC and the board decide what you may say about it. The FTC advertising guidance for small business requires claims to be truthful and substantiated; a menu that implies outcomes has crossed a line before anyone has been treated. The board's advertising rules add to that.
IRS Publication 502 lists physical therapy as a medical expense, so a cash-pay visit can come out of an HSA or FSA. Gym and general wellness memberships generally cannot.
The capacity question
Every new line either fills slots that were empty or displaces slots that were full. Only the first kind adds revenue. Before adding a line, look at the calendar for the last eight weeks and mark the empty slots by day and time.
Does the new line fit?
Does it fill empty slots?
additive, adds revenue
displaces full referred slots
If the line fits there, it is additive. If it needs the slots that referred patients already use, you are choosing between lines. Compare what each slot collects after documentation and no-shows, with the supporting article on this site showing the arithmetic.
Worked example. A follow-up slot runs 45 minutes of treatment plus 10 minutes of notes, 55 minutes of paid therapist time. Three billed units at a typical $32 each collect $96. At a 10 percent no-show and late-cancel rate, booked slots average $86 each, or about $94 per therapist hour.
The same slot sold as a cash session at $110 with 5 minutes of notes brings in $110 in 50 minutes, about $132 per hour. The cash line wins on this arithmetic. Change the no-show rate to 20 percent and the billed slot falls to $77, about $84 per hour. Use your own allowed amounts and rates.
Two lines are cheap in capacity and often overlooked. A group class puts one therapist hour in front of six buyers, so six patients at $25 collect $150 for the hour. A short remote check-in holds a patient inside a plan of care for 15 minutes of therapist time.
Both need the board's answer on supervision and delivery, and both need a policy on what happens when someone does not show.
Records by line
Keep each line's records separate. Then you can answer, for any month, how many visits or sessions each line delivered and what it collected.
Billed lines follow the payer's standard. Self-pay lines need at least a session record, the buyer's signed agreement, and the payment record. Prepaid packages create a liability until delivered, and the accountant will want it tracked.
Adding and dropping a line
Add a line when you can write its five parts, the board and payer questions are answered in writing, the calendar shows where it fits, and the front desk can quote it without calling you.
When to add or drop a line
- Addfive parts written
- Addboard and payer answered in writing
- Addcalendar shows where it fits
- Addfront desk can quote it
- Dropcollects less per slot-hour
- Dropno-show above practice average
- Dropnotes push into unpaid time
Drop a line when it has collected less per slot-hour than the line it displaced for a stated number of months.
Other triggers: no-show rate above the practice average, or documentation burden pushing a therapist's notes into unpaid time. Write the trigger down when you add the line, so dropping it is a rule, not an argument.
Growth of the whole practice is a different question, covered in the startup and market guide. Each new line is also a compliance event, and the licensing and compliance guide lists what to reopen.
What to hand to a professional
- Scope and supervision for any non-standard linethe state board, then a health-law attorney if the answer is unclear.
- Payer coverage and separation of covered and self-pay workthe payer's policy and a compliance adviser.
- Advertising claimsthe FTC guidance above, the board's rules, and a review by someone who is not the person who wrote the menu.
- Prepaid liabilities and revenue recognitionan accountant.
Common questions
What should a cash-pay package cost?
Start from what a slot-hour collects. A single follow-up visit commonly sells for $75 to $150 and an evaluation for $100 to $250. A 6-visit package typically lands 10 to 20 percent below the per-visit rate, so roughly $400 to $750 depending on the market.
Do insurance plans pay for packages?
Generally no. Plans pay per visit through their fee schedule, and Medicare pays allowed amounts up to the KX threshold, which was $2,330 in 2024 and is $2,480 for PT and SLP services combined in CY 2026. A prepaid bundle is a cash product you define, price and track as a liability until you deliver the visits.
Which service lines make the most money?
Nobody can answer that for your practice from a page. The answer is a calculation with your allowed amounts, your slot lengths, your documentation time and your no-show rates.
Rank the lines by what one hour of therapist time collects after notes and no-shows. Three properties decide the order:
- Payment kept. A self-pay line keeps its full price. A billed line keeps the allowed amount, and only after the deductible is met.
- Slot fill. A line that fills empty slots adds revenue. A line that displaces a full slot has to beat what that slot already collected.
- Minutes per visit that do not bill. Every documentation minute lowers the hourly figure.
Ranked that way, group classes and employer hour blocks commonly sit at the top, because one therapist hour serves several buyers or is paid as a block. Self-pay packages and single cash visits commonly come next. Billed visits with heavy documentation and high no-shows commonly come last.
The supporting article on the most profitable services shows how to do it.
Can I offer wellness sessions to patients who have finished their plan of care?
Two answers decide it: scope from the state board, separation from the payer, both covered above. Write both down. The answer is often yes with conditions, and the conditions are the whole point.
Should packages be sold for insurance-covered services?
That is a contract question. Some payer agreements restrict what you may charge their members for covered services. Read the contract and ask the payer before selling anything to an insured patient beyond what the plan pays.
How many lines should a small practice run?
As many as it can write five parts for and staff without pushing documentation into unpaid hours. For most new practices that is two or three, and the discipline is in what you decline.
