Next Event: 2026 Outpatient Therapy Regulatory and Payment Updates
Date: November 19,2025
Medicare Advantage Out-of-Network Billing
I have read so much misinformation on social media platforms regarding the billing of patients who have Medicare Advantage (MA). However, the provider of the therapy services is not contracted with the patients MA plan. Because of this, many therapists and practices may be in violation of federal law and protections for MA beneficiaries regarding out-of-network (OON) billing. In this article, I am going to answer the following questions.
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Our private practice, Proactive Physical Therapy, has a consulting contract with you and I’m not sure if this is where I can ask you a question. If not, please let me know the appropriate place to ask you questions.
My question is regarding your 10/27/25 article about billing Out-of-Network Medicare Advantage plans (second to last drop-down question). If we’re OON with a MA plan and the patient has OON benefits, can we balance bill the patient if we DON’T accept assignment?
Jean Straw, Billing Manager
Thank you for a clear answer on this question as it is asked often. However what should be done if a carrier disregards the selection of item 27 on the 1500 form?
I updated the answer for you.