Rates & insurance
The money conversation, up front
We accept Medicare Part B and self-pay patients. We are out of network with all major commercial insurers. Here is exactly what that means for you.
Medicare Part B
Accepted. Medicare is the payer that reliably covers medically necessary physical therapy and low-frequency, non-contact ultrasound wound therapy when documentation supports it.
Requires: a physician-certified plan of care, and for ultrasound therapy, documented failure of conservative treatment.
Self-pay
Welcomed, with published rates and no surprises. Many patients choose self-pay for rehabilitation services to avoid visit caps, authorization delays, and documentation constraints.
You receive: a written estimate before care begins, and a superbill on request.
Commercial insurance
We are currently out of network with all major commercial plans. Many of those plans also classify ultrasound wound therapy as investigational and will not reimburse it at any network status.
Option: pay our self-pay rate and submit a superbill to your plan for possible out-of-network benefits.
Conservative care documented and failedDay 30 · when advanced therapy becomes billable
Why coverage for advanced wound therapy is narrow
Low-frequency, non-contact ultrasound therapy is billed under a single procedure code, reported once per treatment day. In practice, Medicare is the payer that reimburses it. Commercial medical policies from several major carriers continue to designate the therapy investigational, citing methodological limitations in the published trials.
Medicare does not cover it automatically either. Coverage rests on medical necessity, which means the record has to show that conservative care was tried and failed, that the wound is appropriate for the modality, and that it is responding. Contractors commonly expect reassessment after an initial series of treatments and limit the number of sessions per episode without documented justification.
We build our documentation to that standard from the first visit. We also tell you, before we treat, when we believe a service is unlikely to be covered — so the decision to proceed as a self-pay patient is yours to make with full information.
Good faith estimates
If you are uninsured or choosing not to use insurance, federal law entitles you to a good faith estimate of expected charges before scheduled care. We provide one in writing, and we’re happy to walk through it line by line.
Self-pay rates
- Initial evaluation$160
- Follow-up treatment$120
- MIST ultrasound packagesPlease call for package rates
- In-home visitsPlease call for availability and pricing
Follow-up treatment rate does not include MIST ultrasound. Call (831) 281-3328 for MIST ultrasound package rates and a written estimate.
Billing questions
Will you tell me if something isn’t covered?
Yes, before we provide it. If we believe Medicare is unlikely to pay for a service, you’ll receive advance written notice explaining why and what it will cost, and you decide whether to proceed.
Can I use my HSA or FSA?
Physical therapy is generally an eligible medical expense. Your plan administrator has the final say; we provide itemized receipts that include the information they typically require.
Do you offer superbills for out-of-network reimbursement?
Yes. Self-pay patients can request an itemized superbill with diagnosis and procedure codes to submit to their commercial plan. Reimbursement depends entirely on your plan’s out-of-network benefits, and we cannot promise any particular outcome.
How many visits will I need?
It depends on the wound and on you. What we can promise is that the number is set by your progress and reassessed on schedule — not by what an authorization happens to allow.
What is your cancellation policy?
Please call, text, or reschedule at least 24 hours before your appointment. A $30 missed-appointment fee may apply when a visit is missed without that notice, and it can’t be billed to insurance. We waive it for emergencies and for circumstances outside your control — wounds and weather being what they are, we apply the policy with judgment rather than automatically. The full policy is in your intake packet.
Start with a conversation, not a form
Tell us about the wound or the fall, and we’ll tell you honestly whether we’re the right fit — and what your physician needs to send if we are.