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Toni Talks about PT Today

PT and PTA Reimbursements Are the Same

Published April 24, 2012 1:13 PM by Toni Patt

Jason Marketti made an excellent point last week when he responded to my post. He pointed out that in all but one state, reimbursement is the same for treatments provided by a PT or a PTA. On the surface, that makes sense. Our charges are treatment-based. If I perform gait training, I charge a gait. If Jason performs gait training, he also charges a gait. One gait treatment equals one gait charge.

But things are never so simple. In theory, PTs and PTAs are supposed to be providing equal treatments. That's kind of like saying all PTs provide similar treatments although we know this isn't the case. PTs and PTAs are taught the same treatment techniques. The application is a matter of skill and experience. Maybe a gait is a gait is a gait if the level of skill is the same. In that case, reimbursement for treatment rather than practitioner is appropriate. So what if someone is a clinical specialist? Is that the same treatment too?

Suppose we're talking an involved neurological patient who requires significant hands-on to walk. The gait training I provide would probably be different than that of someone who does less neuro than I do. My treatment would require more skill and be a result of experience. Compare that to a recent total-joint-replacement patient. The skill required for that treatment might simply be cuing for proper sequencing.

In this instance, I would provide a more skilled treatment. Almost anyone could walk with the total-joint patient. Because my treatment was more skilled, should it be reimbursed at a higher amount? Physicians do this all the time. Specialists are expensive. Even specialists who aren't board-certified are able to charge more. It would be easy enough to justify the charge if it was reserved for individuals who are clinical specialists and somehow demonstrate advanced skills. PTAs have their own recognition process and should be included as specialists.

Using skill to justify a different charge with an associated higher reimbursement makes sense. Simply having a DPT couldn't be justification. Doing that would equate a new graduate with an experienced therapist and negate the whole point of charging based on skill. Except for the world of direct access, having a DPT doesn't make much difference.

Imagine what our world would be like if this were in place. Therapists with certifications would be in higher demand. They would be valuable to employers because they can generate increased revenue. That might even equate to increased salaries. Interest in becoming a clinical specialist would also increase if it helped the employment picture. If employers were actually advertising for those skills, more people would want them.

Physical therapy, like every other profession, is hurting in the job market. Facilities have instituted cost-cutting measures that are directly affecting PTs. There are fewer jobs and salaries are flat. Raises aren't what they used to be. Job security has become a real concern. We, as a profession, need something to make us valuable to employers.

This would be an excellent adjunct to Vision 2020; the drive for specialization. The APTA has the resources to pressure insurers and employers in this direction. The PACs raise thousands and thousands of dollars to lobby lawmakers. Over time, it could happen and all PTs and PTAs would benefit. Maybe they'll get around to it after direct access, if they ever get direct access.

It seems like the energies and money of the APTA should be devoted to things that help the most therapists over the long haul. Maybe they'll revisit this issue when more of us are out of work, or not working enough or overqualified for jobs we won't be hired for.


Physical therapy deals with an immense range of different conditions,injuries, illnesses and more. It's also a field which is active both in intensive rehabilitation, long term or semi-permanent treatment and therapy, and also preventative care and wellness.

max moreno May 3, 2012 7:27 AM

Wow.... lots of thoughts to digest here. Recently I was treated by a DPT with a few years experience. I was referred by the orthopedist. The doctor and I had discussed my problem on a few levels... both ortho and possible radiculopathy. I guess he didn't relay all that in his dictation, because the DPT assumed that the doctor was right and followed his script for "A stim" to various scapular areas. I even made sure the DPT knew of the "pins 'n needles" in my hand. After the eval & 2 session of TX with said DPT, my tx was given over to a PTA who "confirmed" that I did not have subacromial bursitis! Say what....?! I asked to be re-evaluated at that point and was told by the DPT that the doctor had missed the DX! This is wrong on so many levels. Now I've stopped PT (so bummed I wasted 5 out of the 20 sessions my ins. allows /year) and have gotten a new referral for the "spine" orthopedist"... only have to wait 3 more weeks for that appt.! As a practicing PT with 3 decades under my belt, I'm not impressed with this nor with a DPT blaming a doctor when the major goal of DPT is direct access! If I didn't know what I know, where would I be in all of this!... probably still wasting my PT sessions on TX that was based on an incomplete hasty eval.. I hope my experience is not common! I hope to hold on to practicing "hands on" but my shoulders and hips are starting to rebel :(  The DPT as the only degree for a PT is misguided... and from experience now on the other side of the plinth... not working so well either! Experience counts... ALOT and the PT profession should allow for "grandfathered in" PT's, master PT's, and the DPT (for those interested in the DPT route). PT services are not able to be given in many areas-mostly rural-because there aren't enough PTs available! I never did "see eye to eye" with the 2020 vision... and now that I see it for what it has actually produced in our field, I'm disappointed and very sad! I haven't been an APTA member in about 6-7 years & don't plan on rejoining any time soon. the 2020 vision is "short-sighted"!

Jeanne April 26, 2012 11:44 AM

Caren, I agree 100% with you second post. That is one (very big) reason why after 22 years of doing what I love, I am changing careers. Physio just isn't the same profession it was when I became licensed and it is losing the very essence of why I became a PT.

Do I still believe in the value of PT? Absolutely! Do I feel that we should be recognised for specialisation, advanced degrees, and meaningful experience? Without a doubt. Do I think it will happen in the remainder of my useful life? No. (Geesh, I talk about myself like a machine that is depreciating!)

I truly hope that I am eventually proved wrong. I will happily eat my words then.

Cheers, Dean

Dean Metz April 25, 2012 4:18 PM

Thank you, Dean for your prompt response. I am glad that we agree on most of this. I meet very few PT's who are secure with taking on private clients and feel that while you are correct that those with means will pay more for what they value, it does not address the majority of the PT workforce.

However, in the facilities and settings that I have practiced for the past 10 years (includeing acute care, outpatient, inpatient rehab, home care and SNF), what you describe is exactly what has happened. The PT's are indeed "evaluation machines," and most not too happy about it. The business model has evolved exactly as you described. The result further supports my argument.

One aspect of the problem is that educated and experienced PT's do not feel valued as advanced treatment providers; they become frustrated paper pushers. Many lament that they do not have time enough to spend providing clinical patient care with their skills of ongoing assessment and planning and instead are burdened with merely filling out the forms to ensure reimbursement.

I see the rub having more of a self-valuation aspect. Good PTs (and particularly newer PTs) want to follow patient progress clinically and learn how to better provide individualized care, in an effort to hone personal clinical skills. They want to practice their craft. Stereotypically, we as a group of clinical professionals want to feel that what we spend time on each day is valuable. We value touching people and direct interaction. Generally, we value direct patient care over paperwork, while realizing that the paperwork is necessary.

While the advanced education and experience do indeed provide a higher level of clinical understanding and expertise, therapists do not feel it is 'valued' by the market because it is not recognized by increased remuneration.

Caren Broo

Caren Brooks, PTA April 25, 2012 2:07 PM
Atlanta GA

Interesting views from Caren. I appreciate your argument on how to raise the value of professionals with a DPT and having an MBA, you are most likely better versed in the business aspects of this than most. I agree that reimbursement based upon experience or skill set would require so much administrative oversight that third party payers would not care to undertake it.

This is where the private pay market makes a big difference. People will pay more for services they perceive to be more advanced, better skilled, or superior in some way to the standard care. I know because I had many private clients when I worked in NYC. They were willing out of pocket for my services. They were also educated consumers who asked if and when I would be getting my DPT and what difference that would make to their treatments and my prices? Unfortunately, most people don't have the option of paying out of pocket for necessary treatment.

That leads us back to third party payers. I see a different outcome than yourself on this one. I see DPTs becoming evaluation machines and the PTAs being the actual treatment providers. As a manager I want my most expensive employees doing the work that gets the highest reimbursement and the less expensive employees doing that which has a lower rate of reimbursement. It is necessary to generate a profit on each visit to be able to pay the admin staff and rent for which there is no reimbursement. Even here in the NHS, as an experienced physio in a higher pay scale, I have to justify to the business managers if I'm doing a job that theoretically could be done by someone in a lower pay scale, such as treatment not involving evaluation or reassessment.

No, I believe the PTA has a healthy future, as does the DPT. It is just that both will be limited in the tasks they can do.

Good discussion, Thanks for posting Dr Patt!

Dean Metz, , Lead Physiotherapist NHS of England April 25, 2012 1:15 PM

This discussion brings to mind thoughts that occurred to me years ago when Vision 2020 was formed.  I agree that from a business perspective, PT and PTA reimbursed charges are indeed the same. This results in a feeling of decreased value for both extensive field experience and advanced education and certification for both PT's and PTA's.  However, from the payer's perspective, as you state, reimbursement is procedurally (CPT) based with professional licensure as the only requirement, and to attempt to attach a higher rate for advanced education or experience would further complicate the ability to ensure equity in the standard of care. It would be more expensive to enforce whether providers actually possessed the advanced abilities and that these improved the actual benefit to the patient. Furthermore, this would indicate that the patient criteria would have to change to indicate a true need for the advanced skills and cost of a more educated or experienced therapist. This potential for conflict would add to the cost of reimbursement, rendering it "bad for business."

I am inclined to believe that in order to exalt Physical Therapists with entry level DPT's (as lesser degrees exit the field by attrition), that the PTA will be phased out as well. I see this as the only way to raise the perceived standard for implementation of Direct Access, and to raise the procedural (CPT) reimbursement rates. I believe that what will happen is that the difference will continue to expand between what is expected of a Physical Therapist and tasks that are delegated to the PTA. This will lower the professional status of the PTA, decrease reimbursement and thus decrease salaries for PTA's, which will ultimately drive students to DPT programs and discourage students from PTA education, (education programs will fold) which over time, will probably cancel the need to license PTA's and the position will take on the appearance of the currently defined PT Aide, whose services are not reimbursed anyway. It is then that the PT will have greater control over defining standards of care and driving up reimbursement rates.

I see this as the impetus behind Vision 2020 and the drive toward specialization and the implementation of entry level DPT's. Direct Access is merely an objective toward the ultimate goal. So, actually advanced education and certification does help PT's over the long haul, to increase their professional standards; and this is indeed what the APTA is promoting through lobbying, working with educators, and ultimately will sell to payers. It will have the desired results that you want, including driving up treatment standards, increasing rates thereby increasing salaries, and making professional recognition more valuable. The downside however will be for the PTA's who are devoted to the care they give and the patients they serve. It is but the nature of the beast, the road to progress. While I am an experienced PTA, and do not have the ambition to return to PT school, I do see the trend and understand the ultimate impact on a more respected, valuable PT profession. I discourage young prospective PTA students and advise them to instead pursue the DPT as a career choice.  Caren Brooks, PTA, MBA

Caren Brooks, PTA April 25, 2012 12:03 PM
Atlanta GA


I absolutely agree with you that specialists in our field should be paid more. I have a Geriatric Wellness Certificate but that does not equate to a higher salary nor does my BS and MA degrees.  A lesser  experienced PTA could cost the company less money and charge the same for exercise and gait.  From an economic stand that makes sense to higher people at lower salaries.

Our patients will suffer the consequences of this action and until they are more educated on specialists in our field and begin to demand the best, nothing will change.

I also wonder what the APTA's thought about this is and why they are focused on other areas.  Maybe they will even drop the RC 3-11 when patients really complain that non qualified personnel are treating them under the direction of a PT and they are being billed for those services.  

Jason Marketti April 24, 2012 10:54 PM

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