When Is Pilates Considered (or Not) To Be Part of Physical Therapy Services?

I offer clinical Pilates sessions and provide receipts for physical therapy, but my client was recently asked to pay back the money she was reimbursed for these sessions.  She now owes the insurer several thousand dollars and I wonder if I made a mistake?

The College has received calls from the public and physical therapists where this scenario has played out after an insurer has audited a claim, reviewed a physical therapist’s clinical record, and determined that the chart did not provide evidence that physical therapy services were delivered.

The client is then asked to reimburse the insurer for the sessions, and in turn, the client requests a refund from the physical therapist because they were under the impression they were receiving reimbursable physical therapy services.

Physical therapists are required to provide physical therapy services that meet College requirements (Bylaws, Standards of Practice, Code of Ethical Conduct), and physical therapy receipts for those services. In the described scenario the physical therapist will need to reflect on what service they provided – were they physical therapy services, or were they Pilates sessions (group or one on one)?  Does the documentation in the client’s clinical record support that physical therapy services were provided, or a Pilates session? The answers to these questions will determine what service was provided and what is written on the receipt.

Physical Therapy Services

One possible answer is that the physical therapist provided physical therapy services and the treatment incorporated Pilates techniques as part of the client’s overall physical therapy treatment plan. A client’s treatment plan likely includes several treatment modalities or techniques to accomplish their physical therapy goals, for example: manual therapy, therapeutic exercise which includes Pilates techniques, education.  When physical therapy services are provided:

  • the treatment plan is connected to assessment findings
  • the client is reassessed, and treatment is progressed accordingly
  • details are documented in the client’s clinical record in a way that meets the requirements set out in Standard 8: Documentation and Record Keeping
  • receipts indicate ‘physical therapy services’, not the specific treatment technique or modality used on a particular day

Pilates Sessions

The other possible answer is that the physical therapist provided Pilates sessions, rather than physical therapy services that meet the College Standards described above. If this is the case, then the accurate way to reflect those sessions would be to write ‘Pilates session’ on the receipt provided, not ‘physical therapy services’. Most insurance plans do not reimburse for Pilates sessions.

The easiest way to think of it is that a physical therapy receipt can only be provided if physical therapy services were delivered, and the receipt should indicate ‘physical therapy services’ – not the individual techniques (i.e. Pilates, exercise, ultrasound, etc.) used as part of the physical therapy treatment plan.

If the services provided do not meet College Standards, in particular Standard 1: Client Assessment, Diagnosis, Interventions and Standard 8: Documentation and Record Keeping, then it is not appropriate to issue a receipt for physical therapy services for those sessions.

 

Published: November 7, 2019