Physical therapy costs swing wildly across U.S. hospitals, and patients pay the price

How much does a physical therapy session cost? The answer depends almost entirely on where you live and what insurance you carry. A Yale study published as a research letter in JAMA Internal Medicine found that commercial payer-negotiated rates for common outpatient physical therapy services vary substantially across U.S. hospitals -- with median evaluation service rates ranging from $151 to $215.

That variation is not trivial for patients. Physical therapy is widely prescribed for acute musculoskeletal injuries, post-surgical rehabilitation, and chronic conditions like osteoarthritis. Evidence consistently supports it as a cost-effective intervention that improves function and reduces the need for more expensive downstream care. But if patients cannot afford their share of the bill, they either underuse the service or stop showing up altogether.

What the data showed

The researchers used data from Turquoise Health, a platform that aggregates the health care prices hospitals are now required to disclose under federal transparency regulations. They examined 10 hospital-based outpatient PT services -- including evaluations and supervised exercise interventions -- at 1,666 hospitals across the country. Many of these services rank among the highest-volume codes billed to Medicare annually.

Three patterns emerged. First, prices varied more between hospitals than within them. A given hospital's rates across different PT services tended to be internally consistent, but two hospitals in different markets could charge dramatically different amounts for the same service. Second, commercial insurer-negotiated prices were generally lower than cash prices -- meaning uninsured patients paid more. Third, rural facilities tended to charge less than urban ones, even after adjusting for geographic differences in health care costs.

The downstream problem

"If you are a patient that is referred to PT, the cost of your care can differ substantially based on your location, your insurance plan, and whether you pay cash for your health care services," said Joshua Skydel, a clinical fellow at Yale School of Medicine and the study's corresponding author. "This may influence how patients engage with longitudinal PT for many medical conditions and has potential implications for downstream health outcomes."

The concern is not just about a single visit. Physical therapy typically involves multiple sessions over weeks or months. Cost pressure that causes a patient to attend eight sessions instead of 16 can affect recovery outcomes, potentially leading to higher costs elsewhere in the system -- more imaging, more specialist visits, or surgical interventions that effective PT might have prevented.

What the study did not answer

The research letter describes a cross-sectional look at prices, not a study of outcomes. It does not quantify actual out-of-pocket costs to patients (which depend on copay structures, deductibles, and coverage limits) or establish a causal link between higher prices and lower utilization. The authors note that additional research is needed to identify the factors driving price variation and to explore whether that variation affects patient outcomes.

"Our hope is that characterizing the widespread variation in prices for these services can help to ensure that care is affordable and fair for patients," said co-author Joseph Ross, professor of medicine and public health at Yale.