Physiotherapist Estimate Template
A physiotherapist estimate forecasts the price before work starts: 8 lines for rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation, totalling $1,230.00, with services the largest share (91%). It states its assumptions and stays valid for 30 days. Edit the lines and download the PDF.
Pre-filled for a physiotherapist: rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation. Example prices: replace them with your own.
From
Granite Physical Therapy Clinic
169 Market Street
Fairview, OR 97024
billing@example.com
(503) 555-0169
Estimate
Prepared for
Dana Whitfield
52 Aspen Way
Springfield, IL 62704
client@example.com
| Description | Qty | Rate | Amount |
|---|---|---|---|
| Physical therapy evaluation, moderate complexity (CPT 97162) | 1 visit | $175.00 | $175.00 |
| Therapeutic exercise (CPT 97110)Range of motion and strengthening | 10 15 min | $40.00 | $400.00 |
| Manual therapy (CPT 97140)Joint mobilization, soft tissue work | 5 15 min | $45.00 | $225.00 |
| Neuromuscular re-education, balance training (CPT 97112) | 5 15 min | $45.00 | $225.00 |
| Kinesiology taping | 3 each | $15.00 | $45.00 |
| Lace-up ankle brace | 1 each | $45.00 | $45.00 |
| Resistance band home exercise kit | 1 each | $20.00 | $20.00 |
| Re-evaluation at discharge (CPT 97164) | 1 visit | $95.00 | $95.00 |
- Subtotal
- $1,230.00
- Estimate total
- $1,230.00
Notes
A physical therapy estimate should lay out the plan of care: expected number and frequency of visits, the fee per visit and any braces or supplies.
Made with Billwise - invoice-pdf-maker-app.web.app
Preview of the PDF. Everything stays in your browser: nothing is uploaded.
Physiotherapist estimate at a glance
| Scope estimated | Rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation |
|---|---|
| Estimate total | $1,230.00 before tax |
| Valid for | 30 days from the estimate date |
| Services (5 lines) | $1,120.00, 91% |
| Products (2 lines) | $65.00, 5% |
| Materials (1 line) | $45.00, 4% |
| Priced in | visit |
Estimate breakdown for rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation
| Item | Type | Est. quantity | Est. amount |
|---|---|---|---|
| Physical therapy evaluation, moderate complexity (CPT 97162) | Services | 1 visit | $175.00 |
| Therapeutic exercise (CPT 97110) | Services | 10 15 min | $400.00 |
| Manual therapy (CPT 97140) | Services | 5 15 min | $225.00 |
| Neuromuscular re-education, balance training (CPT 97112) | Services | 5 15 min | $225.00 |
| Kinesiology taping | Materials | 3 each | $45.00 |
| Lace-up ankle brace | Products | 1 each | $45.00 |
| Resistance band home exercise kit | Products | 1 each | $20.00 |
| Re-evaluation at discharge (CPT 97164) | Services | 1 visit | $95.00 |
| Estimated total | $1,230.00 |
What to write on a physiotherapist estimate
A physical therapy estimate should lay out the plan of care: expected number and frequency of visits, the fee per visit and any braces or supplies.
Materials and products are $110.00 of this $1,230.00 estimate (9%), so say how long those prices hold: supplier prices can move before the job starts.
Charges per treatment visit, with a longer and dearer first evaluation, while insurers are billed by timed treatment codes in 15-minute units.
Assumptions behind each line
Write these next to the 8 lines so the customer sees what the $1,230.00 depends on.
- Physical therapy evaluation, moderate complexity (CPT 97162): 1 visit, $175.00.
- Therapeutic exercise (CPT 97110): 10 15 min, $400.00.
- Manual therapy (CPT 97140): 5 15 min, $225.00.
- Neuromuscular re-education, balance training (CPT 97112): 5 15 min, $225.00.
- Kinesiology taping: 3 each at $15.00 ($45.00); another grade or brand changes this line.
- Lace-up ankle brace: 1 each at $45.00 ($45.00); another grade or brand changes this line.
- Resistance band home exercise kit: 1 each at $20.00 ($20.00); another grade or brand changes this line.
- Re-evaluation at discharge (CPT 97164): 1 visit, $95.00.
Changes, overruns and change orders
If the customer adds work, put it on a signed change order first. Pricing the extra in visit keeps it comparable with the $1,230.00 you estimated.
A 10% rise in material prices would add $11.00 to this job, which is why many physiotherapists limit how long an estimate stays valid.
Tips from physical therapy billing
- Bill timed treatments in 15-minute units and print the total timed minutes for each visit; under Medicare's 8-minute rule the number of units has to fit the minutes actually spent, and auditors check exactly that.
- Show the visit number within the plan of care, such as visit 4 of 12, and the referring physician, because many plans cap therapy visits per year and some require the referral on each claim.
- Braces, tape and bands the patient takes home belong on their own product lines, since plans that pay for treatment often exclude supplies and the patient pays for those directly.
- For self-pay patients, charge a flat visit fee but still print the CPT codes underneath; it lets them seek reimbursement and makes your price comparable with clinics that bill insurance.
Turning the physiotherapist estimate into an invoice
-
Get it approved
Ask Dana Whitfield to sign or reply in writing to estimate EST-6630.
-
Record the changes
Update quantities to what was actually used across the 8 lines.
-
Switch the document type
Change Estimate to Invoice in the tool; the lines and parties stay.
-
Deduct what was paid
Enter any deposit as amount paid so the balance due is correct.
Frequently asked questions
How do I write a physiotherapist estimate?
Describe the job (Rehabilitation of a sprained ankle for a self-pay patient: evaluation, five treatment visits, a brace and a discharge re-evaluation), list each line with an estimated quantity and rate, total it ($1,230.00 in the sample), state how long it is valid and what it assumes, then send it as a PDF for approval.
Is a physiotherapist estimate binding?
An estimate is a forecast, not a fixed price, so the final invoice can differ when the work or materials change. Rules vary by country and state; to stay safe, get written approval before billing noticeably more than the $1,230.00 you estimated.
How long should a physiotherapist estimate be valid?
Thirty days is common and is what this template uses. With 9% of the price in materials, a shorter validity protects you if supplier prices rise.