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Open a Cash-Based Physical Therapy Practice: 5 Things to Consider

By Cindy Bercaw on March 14, 2022



If you’re considering opening a private physical therapy practice, you may be wondering if it’s better to have a cash-based practice.

Many physical therapists are leaning towards cash-based physical therapy because they often run into restrictions with third-party payers, and it interferes with their ability to help patients reach their full potential and goals. There is also the cost of collecting payment from third-party payers to take into consideration. If you’re considering opening (or converting to) a cash-based business, you'll want to know the five things you must consider before taking the leap!

1. Is Your Community Right for Cash-Based PT? 

This step takes some research. You need to know your patient population and understand if most would be willing to pay cash for PT services or not. Is your community a high-income area or low-income area? Are there other successful cash-based practices in the area?

If you’re already running an insurance-based practice, survey your patients and find out how they feel about paying cash upfront for services, rather than going through their insurance.

2. How to Set Up Policies and Fee Schedules to Be Successful in Cash-Based PT

In order to determine your fees, you’ll need to consider your overhead costs, desired profit margin and what you think your patients are willing to pay

You will also need to set up a payment policy. Will all patients be required to pay up front, or will you bill them later? Do you want to offer payment plans, etc.? Whatever you determine, it must be consistent across the board for all patients.

3. How to Help Patients See that Cash-Based Physical Therapy is a Better Value

A lot of patients are used to insurance and may be unfamiliar with cash PT – and they may be concerned that they’ll end up paying more if they don’t go through their insurance companies or find in-network providers. Surprise! “Patients who pay up front in cash often get better deals than their insurance plans have negotiated for them,” (WSJ).

You better be ready to explain this concept to your patients and sell them on the value of your care. Like most cash-based practices, you’ll provide expert, one-on-one care once a week rather than the usual 2-3 times a week some patients will spend at an insurance-based practice. This often means patients end up paying around the same amount for PT – to heal in less time. Most quality-conscious patients will be in favor of that!

4. Marketing Your Cash-Based Physical Therapy Practice

Being an “out-of-network” provider means you may have to market your practice even more than an insurance-based practice. You have a great opportunity to reach direct access patients and show your community why your services are more valuable than other PT services in your area.

Although your marketing efforts won’t be much different than an insurance-based practice’s efforts, if you really want to be successful you’ll work diligently in this department. Most private practice owners don’t have much of a marketing plan and aren’t aggressively pursuing direct access patients. Take the opportunity to differentiate yourself and show patients why YOU are the best option for therapy.

5. What You Need to Know about Medicare and Cash-Based Physical Therapy

Medicare is where things get a bit rocky in the cash-pay model. You can’t accept payment from a Medicare patient for physical therapy services, only for non-covered services. There are other important rules and payment options regarding Medicare patients in this article. While there is no exception to the rule for cash-based practices to accept payment from a medicare patient, there are scenarios you should be aware of and consider if/when specific requests are made on behalf of the medicare patient. You can take a look at some of these scenarios here and what the appropriate actions are regarding these scenarios.



Both PTs and patients can benefit from a cash-pay model in physical therapy – but it’s important to work through all the pros and cons and determine if it’s the right option for your business goals and your patient population.

Did you know FYZICAL consists of both insurance and cash-based practices? Some people think FYZICAL is just a cash-based model, but this is a myth!

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Cindy Bercaw
Written by Cindy Bercaw

Cindy is a rock star content writer for FYZICAL Therapy & Balance Centers. Like a courier of knowledge, neither snow nor rain nor heat nor gloom of night will prevent her from sharing everything you could possibly need to know about succeeding in the business of physical therapy private practice. Cindy maintains a reputation for the imaginative. Recognized as a creative problem solver and divergent thinker, she brings her unique skill set to FYZICAL by helping physical therapists access business knowledge that is designed to help them succeed. She is the lead copywriter for Successful Outcomes Magazine, a publication dedicated to physical therapy private practice owners.

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