If you don’t have health insurance or choose not to use your insurance, you have the right to receive a Good Faith Estimate before scheduled healthcare services. Learn what a Good Faith Estimate is, who qualifies, and how to request one.
What is a Good Faith Estimate
A Good Faith Estimate (GFE) is an estimate of the expected charges for your healthcare services.
Under the No Surprises Act, healthcare providers are required to provide a Good Faith Estimate to patients who do not have health insurance or who choose not to use their health insurance for scheduled healthcare services.
Your estimate is based on the information available at the time it is prepared and reflects the services your provider reasonably expects you will need.
Who can request a Good Faith Estimate?
Anyone is welcome to contact Optimum Therapies to request an estimate of the expected cost of care.
Under the No Surprises Act, patients who do not have health insurance or choose not to use their health insurance for scheduled healthcare services have the legal right to receive a Good Faith Estimate.
If you have questions about your expected costs or would like to request an estimate, our team is happy to help.
Sample Treatment Cost Estimates
Looking for a personalized estimate? Contact us before your appointment, and our team can prepare a Good Faith Estimate based on your expected course of care.
The examples below illustrate estimated costs for common physical therapy treatment plans based on our current private pay pricing. They are provided for informational purposes only and are not a substitute for a personalized Good Faith Estimate. Your recommended plan of care, number of visits, and total cost will vary based on your individual needs and your physical therapist’s clinical evaluation.
| Surgery/Condition | Average Visits | Estimated Total Cost |
|---|---|---|
| Bunionectomy | 7 | $840 |
| Carpal Tunnel | 8 | $960 |
| Hip Arthroscopy | 10 | $1,200 |
| Knee Arthroscopy | 12 | $1,440 |
| Total Hip Replacement | 12 | $1,440 |
| Achilles Repair | 12 | $1,440 |
| Microdiscectomy/Laminectomy | 12 | $1,440 |
| Cervical Fusion/Disc Replacement | 12 | $1,440 |
| Total Knee Replacement | 13 | $1,560 |
| Shoulder Arthroscopy/Debridement | 15 | $1,800 |
| ACL Reconstruction | 16 | $1,920 |
| Lumbar Fusion | 16 | $1,920 |
| Rotator Cuff Repair | 18 | $2,160 |
Please note: The sample treatment plans above are examples only. Your personalized Good Faith Estimate will be based on your individual condition and expected course of care.
Common Physical Therapy Charges
The following table lists our current standard charges for common physical therapy services.
Patients using insurance typically pay the amount determined by their individual insurance plan, which may differ from these standard charges.
| Treatment/CPT Code | Billed as a single unit | Medicare Reimbursement |
|---|---|---|
| Moderate PT Evaluation/97162 (visit 1) | $212.10 | $95.70 |
| PT Re-Evaluation/97164 | $108.15 | $65.77 |
| Neuromuscular Re-Education/97112 | $86.10 | $31.84 |
| Manual Therapy/97140 | $82.95 | $26.94 |
| Therapeutic Exercise/97110 | $82.95 | $28.25 |
| Therapeutic Activities/97530 | $82.95 | $34.00 |
| Cash-Based Programs | $60.00 | At time of Service |
Please note: These charges represent our current standard rates for the services listed. Your actual financial responsibility may differ depending on your insurance coverage, contractual adjustments, or whether you choose to pay privately.
Your Rights Under Federal Law
Under the No Surprises Act, patients who do not have health insurance or choose not to use their health insurance have the right to receive a Good Faith Estimate before receiving scheduled healthcare services.
A Good Faith Estimate is based on the information known at the time it is created and reflects the healthcare services your provider reasonably expects you will need. It does not include any unknown or unexpected costs that may arise during treatment. If your healthcare needs change, your final charges may differ from your Good Faith Estimate.
If you are billed at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal patient-provider dispute resolution process.
If you have questions about your estimate or your bill, we encourage you to contact Optimum Therapies first. Our team is happy to answer questions, explain charges, and discuss your options.
For complete information about your rights under the No Surprises Act, the federal dispute resolution process, and applicable deadlines, visit www.cms.gov/nosurprises or call 1-877-696-6775.
We also encourage you to keep a copy of your Good Faith Estimate for your records.
Frequently Asked Questions
Who qualifies for a Good Faith Estimate?
Patients who do not have health insurance or who choose not to use their insurance for scheduled healthcare services have the legal right to receive a Good Faith Estimate. Anyone is welcome to contact us to request an estimate of expected costs.
Does a Good Faith Estimate guarantee my final cost?
No. A Good Faith Estimate is based on the information available before treatment begins. Your actual charges may change if your healthcare needs or treatment plan change.
What if my final bill is higher than my estimate?
If your final bill is at least $400 more than your Good Faith Estimate, you may have the right to begin the federal patient-provider dispute resolution process. Visit www.cms.gov/nosurprises for more information.
Can I request an estimate if I have insurance?
Yes. Anyone is welcome to contact us to discuss expected costs. However, the legal right to receive a Good Faith Estimate under the No Surprises Act applies to patients who do not have health insurance or who choose not to use their health insurance for scheduled healthcare services.
Have more questions?
If you have questions about your Good Faith Estimate, private pay pricing, billing, or insurance coverage, our team is here to help.
Billing Department
Phone: (715) 855-0430