Insurance and referrals
Does insurance cover pelvic floor physical therapy?
Yes. Pelvic floor physical therapy is billed as physical therapy, which nearly every commercial plan, Medicare, Medicaid, and TRICARE cover when it is medically necessary. Coverage follows the plan's physical therapy benefit: its copay or coinsurance, any deductible, visit limits, and whether a referral is required.
The details
What to know
Answered by the practice of Dr. Elana Shalem, DPT, pelvic floor and orthopedic physical therapist.
There is no separate "pelvic floor" benefit. The diagnosis codes for incontinence, prolapse, pelvic pain, postpartum weakness, and the rest are covered diagnoses, and the treatment codes are the standard physical therapy codes. What varies is the plan's rules for physical therapy in general.
Three things to check before the first visit: whether the provider is in-network with the specific plan, whether a referral or prior authorization is required, and how many visits per year the plan allows. A practice that verifies benefits does this for the patient.
Telehealth physical therapy is covered by most plans today, including Medicare, when the provider is licensed in the state where the patient is located at the time of the visit.
EMS Therapy verifies benefits before every new patient's first visit and offers private pay with superbills where it is not in-network.
Where you live
Tell us where you are
Insurance, referral rules, and booking depend on where you live. Choose your area and we take you to the right page.
Not listed? Dr. Shalem can only treat patients located in a state where she holds a license. Send a message and we will tell you what is possible.
How it works
How a virtual visit works
Most of pelvic floor physical therapy is education, breathing and pressure management, movement retraining, and a home program. All of it works on camera. During the evaluation, Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating with breath and movement. An internal examination is not possible by video; if a hands-on assessment would change the plan, she says so and helps the patient find local care.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed physical therapist.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.