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we make getting the help you need easy.

Insurance shouldn’t stand in the way of recovery. Whether you’re covered by Medicare or paying out of pocket, we’ll help you understand your benefits and guide you through reimbursement options so you can focus on what matters, getting better.

Understanding Your Physical Therapy Coverage

At Congruence Physical Therapy & Wellness, we believe clarity equals confidence. Many of our patients come to us unsure if physical therapy is covered by insurance or how reimbursement works.

The truth? Most plans, including Medicare, do provide benefits for physical therapy. For others, we make care affordable through our cash-based model and Superbill reimbursement process.

Below, we’ve answered the most common insurance questions we hear so you know exactly what to expect before your first visit.

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Physical Therapy Insurance Frequent Asked Questoins

Is physical therapy covered by insurance?

Yes. Congruence Physical Therapy & Wellness is in-network with Original Medicare and most supplemental plans. We also accept Medicare Advantage plans; copays and visit limits vary by provider. For all other insurance types, we operate as a cash-based clinic—but we’ll give you a Superbill to submit for out-of-network reimbursement.

How do I get reimbursed if you’re out of network?

We’ll provide a detailed Superbill after each visit. You submit it to your insurance provider for reimbursement under your out-of-network physical therapy benefits. The payment from your insurer goes directly to you, not the clinic.

Do I need a referral to start physical therapy?

In most cases, no referral is required. California allows direct access to physical therapy, meaning you can book an evaluation without a doctor’s note. Some insurance companies still ask for a referral for reimbursement, so check your plan or ask our team to confirm before you start.

Can you help me verify my insurance benefits?

Absolutely. Send us your insurance details and we’ll check your benefits before your first appointment. Even if we’re out of network, we’ll explain exactly how reimbursement works for your plan.

What does “cash-based physical therapy” mean?

Cash-based simply means you pay for sessions at the time of service—using cash, card, check, or FSA/HSA funds. This model removes insurance restrictions and allows us to spend more one-on-one time focusing on your goals. Many patients later receive reimbursement from their insurance company.

What is a Superbill and what does it include?

A Superbill is a document that lists your provider information, tax ID, diagnosis (ICD-10) and treatment codes (CPT). It’s everything your insurer needs to decide if they’ll reimburse you for care you’ve already paid for.

Why don’t you participate with all insurance companies?

Traditional insurance contracts often limit treatment time and reimbursement based on generic rates—not your therapist’s expertise. By remaining out of network, we maintain higher quality care, longer sessions, and personalized treatment without restrictions.

How much does physical therapy cost with insurance?

Costs vary depending on your plan, deductible, and copay. If you’re covered under Medicare, most sessions have a small coinsurance. For private insurance, rates depend on your provider’s out-of-network benefits. If you’re paying directly, our cash-based rates are transparent—you’ll always know the cost before your session, with no surprise bills afterward.

Still Not Sure?

We'll help you find what's right for you.

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Let’s Make Insurance Easy—So You Can Focus on Healing.

We’re here to help you navigate coverage, costs, and next steps with clarity. Whether you use Medicare, private insurance, or pay directly, our team will guide you through the process and provide all the documentation you need for reimbursement.

Serving Sunnyvale CA and nearby communities | Medicare Accepted

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