Post-surgical physical therapy under Letter of Protection in Florida PI cases.
Physical therapy after orthopedic or spine surgery is a non-negotiable component of surgical recovery in Florida PI cases. Without structured post-operative rehabilitation, surgical outcomes deteriorate, functional recovery stalls, and the case loses the documented recovery narrative that maximizes settlement value. In most Florida PI surgical cases, post-surgical PT is funded through a Letter of Protection because PIP has already been exhausted. Understanding the LOP structure, the §768.0427 billing cap, and the documentation requirements for each surgical protocol is essential for attorneys and providers managing these cases.
Post-surgical PT protocols for the most common Florida PI surgeries.
Anterior Cervical Discectomy and Fusion (ACDF) produces the most protocol-intensive post-surgical PT requirement among Florida PI spine cases. ACDF rehabilitation proceeds in distinct phases. The immobilization phase (weeks 0-6) focuses on pain management, cervical isometrics, and upper extremity ROM to prevent shoulder capsule stiffening while protecting the fusion site. The early mobilization phase (weeks 6-12) introduces cervical ROM exercises as fusion consolidation is confirmed on imaging. The strengthening phase (months 3-6) builds cervical and parascapular musculature to support the fused segment and reduce adjacent-segment stress. Post-ACDF PT typically runs 3-5 months with 2-3 visits per week, totaling 24-50 visits.
Lumbar microdiscectomy has a faster post-surgical PT recovery arc. Patients are typically walking within 24 hours of surgery. PT begins within the first post-op week with core stabilization, hip strengthening, and posture training to protect the surgical site. The return-to-activity phase (weeks 4-12) adds progressive loading. Most uncomplicated microdiscectomy patients are discharged from formal PT at 8-12 weeks, with the caveat that patients with pre-op neurological deficits require longer rehabilitation. Lumbar fusion recovery is more intensive and more prolonged, typically 6-12 months.
ACL reconstruction rehabilitation follows a well-established protocol with six phases: immediate post-op (weeks 0-2, quad set, straight leg raises, cryotherapy), early mobilization (weeks 2-6, full ROM, cycling), strengthening (weeks 6-12, progressive resistance), neuromuscular training (months 3-6, balance and proprioception), return-to-sport training (months 6-9), and return-to-sport testing (months 9-12). This protocol is rigorous, visit-intensive, and generates substantial PT billing: a full ACL reconstruction PT course typically involves 60-90 visits over 9-12 months at PI rates.
Rotator cuff repair rehabilitation is phase-driven by tissue healing constraints. Phase I (weeks 0-6) is purely passive: the arm is immobilized in an abduction sling and the therapist performs passive range of motion only. Active-assistive motion begins at week 6; active motion at week 12. Strengthening begins at month 4 and continues through month 6 for small tears, month 9 for large tears. Massive cuff repairs may not allow full strength recovery for 12 months. PT billing for rotator cuff repair cases spans 4-12 months depending on tear size and surgical complexity.
CPT global period rules affect post-surgical PT billing in a frequently misunderstood way. Major surgery CPT codes carry a 90-day global period, during which the surgeon's routine post-operative care visits are included in the surgical fee. Physical therapy is explicitly excluded from the global period and is billed and reimbursed separately regardless of the 90-day window. However, it is not uncommon for PIP or health insurance adjusters to deny post-op PT claims within the 90-day global period, claiming the services are bundled. This is incorrect and should be challenged with documentation that PT is a separate and distinct service not included in the global surgical fee.
How post-surgical PT flows through a Florida PI case under LOP.
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Pre-surgery
Execute a separate PT LOP before the operation
Before surgery, the attorney should execute a separate LOP with the physical therapy provider. If the orthopedic or spine surgeon is in-network on the LOP, the PT provider may be a separate entity requiring its own agreement. Waiting until after surgery to execute the PT LOP creates gaps in coverage and delayed PT onset, which harms both clinical outcomes and the case record.
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Post-op week 1-2
Initial PT evaluation
PT evaluation within 1-2 weeks of surgery (or sooner per the surgeon's orders). Documents: surgical procedure performed, surgeon's discharge instructions and restrictions, baseline ROM and strength, pain scores, and functional status. The PT evaluation note should reference the surgical operative report and confirm alignment with the surgeon's post-op protocol.
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Month 1-3
Intensive phase PT
2-3 visits per week during the intensive rehabilitation phase. CPT codes for post-surgical PT include 97162-97163 (evaluation), 97110 (therapeutic exercise), 97140 (manual therapy), 97116 (gait training, for lower extremity cases), 97530 (therapeutic activities), and 97012 (traction, for spine cases). Each visit note documents the specific exercises performed, timed units, and objective functional progress.
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Month 3-6
Progressive strengthening and functional training
Frequency often reduces to 2 visits per week as home exercise program independence increases. ROM and strength measurements at each re-evaluation track objective recovery. For ACL and rotator cuff cases, neuromuscular training and return-to-activity testing dominate this phase. Attorneys can use progress reports from this phase to establish functional recovery trajectory for damages narratives.
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PT discharge
Discharge summary and MMI
Formal discharge summary documents: final ROM and strength measurements, functional outcome scores, comparison to baseline, whether surgical goals were achieved, any residual functional deficits, and PT MMI status. If residual deficits exist, the PT should state whether further improvement is possible with additional treatment and estimate the future PT need and cost.
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Lien resolution
PT LOP lien at settlement
The PT LOP lien is negotiated at settlement along with the surgical LOP lien. PT lien amounts are typically more easily reduced than surgical liens because the dollar amounts are smaller relative to the overall case. Under §768.0427, the admissible LOP PT amount for uninsured patients is 120% Medicare; the lien negotiation typically reduces collections to a figure somewhere between 120% Medicare and the full contracted LOP rate.
LOP billing for post-surgical PT under §768.0427 in Florida.
Post-surgical PT is billed using the same CPT codes as standard PT, but the visit structure, frequency, and protocol are more intensive and more defined. The most common post-surgical PT CPT codes are therapeutic exercise (97110), manual therapy (97140), neuromuscular re-education (97112), therapeutic activities (97530), gait training (97116), and re-evaluation (97164). For spine surgery cases, traction (97012) and mechanical diagnostic testing may also be billed. Post-surgical evaluations use the higher-complexity codes (97162-97163) given the complexity of post-operative status.
Under §768.0427, for uninsured patients treated under LOP, the admissible value of PT bills at trial is capped at 120% of Medicare Part B rates. For a standard 60-minute post-surgical PT session billing therapeutic exercise and manual therapy, 120% Medicare produces approximately $90-$130 of admissible PT billing per visit. A full 9-month ACL reconstruction PT course with 80 visits at 120% Medicare produces approximately $7,200-$10,400 in admissible PT medical damages. Post-ACDF PT at 40 visits produces approximately $3,600-$5,200 at 120% Medicare.
The timing of PT LOP execution is a practical litigation consideration. If the attorney waits until after surgery to arrange PT, there is typically a gap of days to weeks before PT begins, which defense can exploit as evidence that the PT was not medically urgent or continuous. Pre-surgical execution of the PT LOP eliminates this gap and ensures PT begins per the surgeon's protocol immediately post-discharge.
PIP, if not already exhausted by the pre-surgical treatment, technically covers post-surgical PT. However, in most Florida PI surgical cases, PIP has been exhausted during the pre-surgical diagnostic and conservative care phase. The practical assumption for attorney case planning is that post-surgical PT will be 100% LOP-funded. Confirming PIP exhaustion before surgery allows accurate LOP planning and avoids over-reliance on PIP funds that may no longer be available.
What attorneys need from a post-surgical PT record.
Protocol alignment with surgeon orders
PT records must document that the rehabilitation protocol was aligned with the surgeon's post-op instructions. Discrepancies between the surgeon's protocol and the PT treatment plan are a defense target. The PT initial evaluation should quote or reference the surgeon's protocol, and any deviations should be explicitly documented with clinical rationale.
Objective recovery trajectory
ROM measurements, strength testing, and functional outcome scores at each re-evaluation create the recovery arc that attorneys use to demonstrate progress. For damages purposes, a patient who goes from 20-degree cervical lateral flexion at post-op week 2 to 45 degrees at week 12 has a documented, objective recovery that is harder to minimize than 'patient reports improved pain'.
Functional limitation and work restriction documentation
PT notes should document specific functional limitations and work restrictions at each visit. 'Patient is unable to perform overhead reaching required by job duties as an electrician' is specific and legally useful. 'Patient has limited function' is not. PT functional limitation documentation supports wage loss claims and non-economic damages narratives.
Discharge summary with residual deficits
The discharge summary must document whether the patient achieved full recovery or has residual deficits. Residual strength deficits, ROM limitations, and persistent functional restrictions at discharge support future damages awards and are the PT record's contribution to the permanency analysis.
Frequently asked questions.
Does Florida PIP cover post-surgical PT?
PIP covers medically necessary PT, including post-surgical PT, up to the applicable benefit limit ($10,000 with EMC certification). In most Florida PI surgical cases, PIP has been partially or fully exhausted before surgery. Post-surgical PT is therefore typically funded under LOP. If any PIP benefit remains, it should be applied to post-surgical PT before LOP begins.
Does the 90-day surgical global period prevent billing PT separately?
No. Physical therapy is explicitly excluded from the surgical CPT global period and is always billed and reimbursed separately. The global period includes routine surgical follow-up visits by the operating surgeon, not PT services provided by a separate physical therapist. PIP and LOP payers who deny PT claims within the 90-day global period are making an incorrect coverage determination.
How long does post-ACDF physical therapy take?
ACDF rehabilitation typically runs 3-6 months, beginning with passive cervical isometrics and upper extremity ROM in the first 4-6 weeks, transitioning to active cervical ROM after fusion consolidation is confirmed (typically at the 6-12 week X-ray), and advancing to full strengthening at 3-6 months. Visit frequency is 2-3 times per week, totaling 36-72 visits for a standard single-level ACDF.
What is the post-surgical PT cost for an ACL reconstruction in a Florida PI case?
A full 9-12 month ACL reconstruction rehabilitation course involves 60-90 visits at 2-3 visits per week. At 120% Medicare for uninsured LOP patients under §768.0427, the admissible PT bill for a 75-visit ACL course runs approximately $6,750-$9,750. At the provider's full LOP contracted rate (which may be higher), the total bill may be $12,000-$18,000 before lien negotiation.
When should a PT LOP be executed relative to surgery?
Ideally before surgery, and at minimum at the time of surgical scheduling. Pre-surgical LOP execution ensures: (1) PT can begin immediately per the surgeon's post-discharge protocol, (2) there is no gap in coverage that defense can exploit, and (3) the attorney has clarity on the total projected LOP medical spend before surgery.
Does NPA make introductions to physical therapists for post-surgical cases?
Yes. NPA makes introductions to vetted Florida PI physical therapists with post-surgical rehabilitation experience in all 10 Florida regions. The attorney selects the PT provider. The PT evaluates and treats the patient per the surgeon's protocol. NPA does not direct clinical care.
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Tell us the surgery performed, the region, and the expected post-op start date. NPA makes the introduction to a PI-experienced physical therapist who follows protocol and documents for litigation. You choose the provider. They treat the patient.