Cash vs Insurance Physical Therapy Revenue Calculator
With 80 insurance visits a week at $95, 90% collected and 8% billing cost, you net about $6,290 a week. At $175 cash per visit you break even keeping 46% of that volume, about 37 visits a week.
The question owners actually ask is not "is cash better?" but "how many patients can I lose and still be fine?" This calculator answers that with your own numbers. At the defaults the answer is about 46% of your current visit volume, but the result swings hard with your reimbursement rate and your cash price, so put in real figures from your EMR and biller.
- Weekly net on insurance today
- $6,293
- Weekly net on cash at 50% of volume
- $6,790
- Difference per month
- $2,153
How does the cash vs insurance break-even work?
The break-even is the number of cash visits a week that brings in the same net revenue you collect from insurance today. The calculator first finds your weekly insurance net: visits times average reimbursement, times your collection rate, minus your billing cost. Then it finds what one cash visit nets after about 3% card processing. Divide the first by the second and you get the cash visits you need. Divide that by your current visit count and you get the share of volume you have to keep. Below that share you make less; above it you make more. The model also shows what happens if you keep the share you enter, so you can compare a cautious guess with an optimistic one.
What does each input mean and where do I get it?
Each input should come from your own billing data; the defaults are placeholders, not benchmarks. Reimbursement depends on your payer mix and contracts. For reference, U.S. Physical Therapy, a large public outpatient chain, reported a net rate of $105.54 per visit in the third quarter of 2025. Medicare rates reset every year; CMS set the 2026 physician fee schedule conversion factor at $33.40 for most clinicians, up 3.26% from $32.35. Collections lose money to denials: in Experian Health's 2025 State of Claims survey of 250 provider finance and billing staff, 41% reported denial rates of 10% or higher. Billing cost depends on who does it; a September 2026 Physitrack article says outsourced PT billing services commonly charge 4% to 8% of collections, a vendor estimate rather than an independent benchmark.
| Input | Default | Reference point | Where to get yours |
|---|---|---|---|
| Insurance visits per week | 80 | None, clinic specific | EMR visit report |
| Average reimbursement per visit | $95 | USPH net rate $105.54 (Q3 2025) | Payments ÷ visits, last 6 months |
| Collection rate | 90% | 41% of providers report 10%+ denials (Experian, 2025) | Collected ÷ expected |
| Billing cost | 8% | Outsourced billing 4% to 8% (Physitrack, 2026) | Biller invoices + staff time |
| Cash rate per visit | $175 | Your planned fee | Your pricing |
| Share of volume kept | 50% | Your estimate | Patient survey, waitlist, your market |
The 3% card fee is built in and not editable. Stripe's standard US online rate is 2.9% plus 30 cents per charge (checked October 2026), which on a $175 visit is about 3.1%.
What does the calculator show with the default numbers?
With the defaults the calculator shows you need to keep 46% of your visit volume, about 37 cash visits a week, to match insurance. The insurance side: 80 visits times $95 is $7,600 billed, 90% collected is $6,840, and 8% billing cost leaves $6,292.80 a week. The cash side: $175 minus 3% processing nets $169.75 a visit, so $6,292.80 divided by $169.75 is about 37 visits, or 46% of 80. If you keep half your volume, 40 visits, you net $6,790 a week, about $497 more than insurance, which the calculator shows as roughly $2,153 more per month. Drop the cash rate to $150 and the break-even jumps to about 54%; raise reimbursement to $110 and it moves to about 54% as well. Small changes in either input move the answer a lot.
What does the result mean for my decision?
The result tells you how much volume you can lose before cash pay costs you money, which is a revenue question, not the whole decision. If the break-even is 35% and you believe you can keep 60%, the math leans toward cash. If the break-even is 70%, you probably need a higher cash rate, a hybrid model, or a stronger plan to bring in new cash patients first. Fewer visits at a higher rate also means fewer hours treating for the same income, which some owners value more than the extra dollars. For the full decision, including Medicare and contract exits, read should I drop insurance, and if the break-even looks too high, look at a hybrid cash and insurance practice.
What does the cash vs insurance calculator leave out?
The calculator leaves out marketing cost, capacity limits, the time it takes to rebuild volume, and overhead that changes when you stop billing insurance. Marketing is the big one: insurance directories and physician referrals send patients you did not pay to acquire, and a cash clinic usually replaces some of that with paid ads. See what a new patient costs by channel and subtract a realistic monthly ad budget from the cash side. Capacity matters too: if you are already full, keeping 100% of volume is not possible after a switch anyway. And the transition takes months, so plan for a dip. Some costs go down, such as billing staff, clearinghouse fees and time on authorizations, which the billing cost input only partly captures.
This is general information, not legal or billing advice; check your state board and a healthcare attorney before you change how you bill.
Questions owners ask
How many patients do I need to keep to go cash-based?
It depends on the gap between your net insurance revenue per visit and your cash rate. At the calculator's defaults ($95 reimbursement, $175 cash) you break even keeping about 46% of your visit volume.
What is a typical insurance reimbursement per physical therapy visit?
It varies by payer, state and contract. U.S. Physical Therapy, a large public outpatient chain, reported a net rate of $105.54 per visit in the third quarter of 2025, which is one reference point, not your number.
Does the calculator include marketing costs?
No. It compares revenue only. A cash clinic usually needs to spend more on marketing to replace referral and insurance-directory volume, so subtract your expected ad spend from the cash side.
What collection rate should I use?
Use your own: total collected divided by total expected reimbursement over the last 6 to 12 months. If you do not know it, your biller or EMR's accounts receivable report can tell you.