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Super Bill Request
Request of Super Bill from Perfect 10.0 Physical Therapy, PLC.
Service Description
A completed list of dates of service along with ICD-10 codes will be provided. Request for Superbill from Perfect 10.0 Physical Therapy, PLC for insurance reimbursement purposes. We would like to inform you of our Superbill Policy update, starting 1/1/2025. Our practice is a cash-based physical therapy clinic that does not participate with any insurance companies. If you have out-of-network coverage, you can file for reimbursement, pending services. We will provide the eligible codes for you at a cost of $64.98 per Superbill Request, starting 1/1/2025 along with a 3% increase in all services provided. You are now able to submit a Superbill Request at any time. We are offering this provision to make information more readily accessible and convenient to you. This is not reimbursable by insurance and will therefore not be itemized into a Superbill. Please email admin@perfect10pt.org for specific pricing questions for this service or for your specific gym affiliation. ATTN: We are a cash-based, fee-for-service medical practice and do not accept insurance of any kind. This service is not covered my government issued insurance (ie. Medicaid, Medicare Part A and B and Tricare) and therefore is not reimbursable and will not be itemized into a Super Bill.
Cancellation Policy
To cancel an appointment, or to reschedule please email, text or call the office 24 hours PRIOR to your appointment. If you cancel less than 24 hours in advance there will be a same service charge as a cancellation fee. If you reschedule a cancel appointment within the same week, the cancelation fee will be waived. If you do not show to your appointment there will be a same service charge for a no show fee. If payment is not received prior to appointment, you cannot be seen. There is a $54 non refundable deposit fee to reserve your booked Evaluation appointment time. AGAIN, this is a non-refundable deposit and is NOT associated with the cost of the Initial Evaluation. Full payment for the Evaluation is due at the time of service and will be billed to the card we have on file. Pricing can be found in the New Patient Paperwork located on our Home Page under "More" pages 25-26. Please email admin@perfect10pt.org for specific pricing questions for this service or your specific gym affiliation. ATTN: We are a cash-based, fee-for-service medical practice and do not accept insurance of any kind. This service is not covered my government issued insurance (ie. Medicaid, Medicare Part A and B and Tricare) and therefore is not reimbursable and will not be itemized into a Super Bill. Thank you!
Contact Details
Cardinal Gymnastics, Guinea Road, Fairfax, VA, USA
+15712529131
egreene@perfect10pt.org
7500 Limestone Drive, Gainesville, VA, USA
+15712529131
egreene@perfect10pt.org
Dynamic Gymnastics, Carlin Springs Road, Bailey's Crossroads, VA, USA
+15712529131
egreene@perfect10pt.org