Downloads

Good Faith Estimate

OSO Physical Therapy PC provides "out-of-network" or "private pay" services, providing a Good Faith Estimate (GFE) is a legal requirement under the No Surprises Act (effective January 1, 2022).

Good Faith Estimate Notice

Provider: OSO Physical Therapy

Website: osophysicaltherapy.com

Your Right to Receive a Good Faith Estimate

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • Transparency: You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Timing: Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • Dispute Resolution: If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Record Keeping: Make sure to save a copy or picture of your Good Faith Estimate.

Estimated Costs for Physical Therapy Services

The following table outlines the standard charges for common services at OSO Physical Therapy. Please note: Total costs will depend on the duration and frequency of treatment recommended during your initial evaluation.

Service Code (CPT) Description Estimated Rate
97161 – 97163 Initial Physical Therapy Evaluation $55
97110 Therapeutic Exercise (per 15 min) $55
97112 Neuromuscular Re-education (per 15 min) $55
97140 Manual Therapy (per 15 min) $55
97530 Therapeutic Activities (per 15 min) $55

Important Disclaimers

  • This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

  • The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.

  • This estimate is not a contract and does not require you to obtain the services from OSO Physical Therapy.

Questions or Disputes?

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.