Good Faith Estimate Standard Notice

Effective January 1, 2022

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate.

Lift Laugh Kegel Physical Therapy does not take part in surprise billing. Payment is due at the time of service, with evaluations costing $200 (in-home) or $160 (video), and follow-up visits costing $160 (in-home) or $120 (video), regardless of diagnosis or performed services.

Lift Laugh Kegel Physical Therapy’s NPI number is 1205202744. Billed CPT codes may include Physical Therapy Evaluation (97161), Reevaluation (97164), Therapeutic Exercise (97110), Neuromuscular Reeducation (97112), Therapeutic Activity (97530), and/or Manual Therapy (97140).

Lift Laugh Kegel PT may recommend additional services or items as part of the course of care that must be scheduled or requested separately and are not reflected in this good faith estimate. This information is only an estimate of what is reasonably expected to be furnished at the time the good faith estimate is issued and is not a contract.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (512)537-9833.

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