PAYING FOR CARE · STAFFORD & FREDERICKSBURG, VA
Medicare And Direct-Pay Physical Therapy
Medicare is the one place where "just pay directly and we'll give you a superbill" is not automatically true, and a practice that tells you otherwise is being careless with rules that exist to protect you. This page explains the real distinctions, plainly, and ends with the only reliable instruction: raise Medicare on your discovery call before anything is scheduled.
THE RULES, WITHOUT THE HAND-WAVING
What is Divine Physical Therapy's Medicare status?
Divine Physical Therapy is not enrolled as a Medicare provider. Dr. Thea Paige has an active Type 1 individual NPI (1861875981) and an active Virginia physical therapy license (VA PT License #VA2305209500), but an NPI and professional license are separate from Medicare enrollment.
Medicare enrollment requires a separate federal enrollment process. Divine Physical Therapy has not completed that enrollment and should not be described as Medicare "participating" or "non-participating." Both of those terms refer to Medicare-enrolled providers or suppliers.
Most websites either dodge this topic or get it wrong. Neither serves you.
Reviewed by Dr. Thea Paige, PT, DPT, CMTPT, PCES
WHY THIS PAGE EXISTS
Why Is Medicare Different From Commercial Insurance?
With commercial insurance, a direct-pay arrangement is simple: you pay the practice, request a superbill, and submit it to your insurer for whatever out-of-network benefit your plan allows. Medicare Part B does not work that way. Federal rules govern how, and whether, a physical therapist may accept private payment from a beneficiary for services Medicare covers, and those rules attach to the provider's enrollment status, not to anyone's preference.
This is a regulatory distinction, not a business decision. A practice can choose not to contract with a commercial insurer and hand you a receipt; it cannot simply choose to ignore Medicare's billing framework for a beneficiary's covered care.
That is why the sentence "we'll just give you a superbill," perfectly accurate for commercial plans, as explained on superbills and out-of-network reimbursement, cannot be automatically extended to Medicare.
THREE TERMS, THREE DIFFERENT MEANINGS
Not Enrolled, Non-Participating, And Opted Out Are Not The Same Thing.
Not Enrolled
Divine Physical Therapy is currently not enrolled in Medicare.
Non-Participating
A Medicare non-participating provider is still enrolled in Medicare but has not agreed to accept assignment on every Medicare claim. That is not Divine's current status.
Opted Out
Opting out is another formal Medicare status. CMS specifically lists physical therapists among the provider types that are not eligible to opt out. CMS also states that providers who do not see Medicare patients do not have to enroll or opt out.
Medicare beneficiaries should therefore contact Divine before scheduling rather than assuming Medicare-covered physical therapy can be handled like ordinary commercial out-of-network care.
Medicare's private-payment rules attach to two hinges at once: the provider's enrollment status and whether the service is Medicare-covered. Covered therapy services generally must flow through Medicare's billing framework via an enrolled provider, which is why a non-enrolled therapist cannot simply accept cash from a beneficiary for covered care, and why a superbill cannot substitute for enrollment the way it substitutes for a commercial network contract.
IDENTIFICATION IS NOT ENROLLMENT
What Does Dr. Paige's NPI Mean?
Dr. Paige's Type 1 NPI is 1861875981. It identifies her as an individual healthcare provider. Her primary Virginia taxonomy is Physical Therapist (225100000X), and her Virginia PT license is #VA2305209500.
An NPI identifies a healthcare provider for healthcare transactions. It does not by itself enroll a clinician or practice in Medicare, Medicaid, TRICARE, or a commercial health plan.
NPI ≠ Medicare enrollment. A Type 1 or Type 2 NPI identifies a healthcare provider or organization for healthcare transactions. Enrollment and credentialing with Medicare and other health plans are separate processes.
PAYMENT AND COVERAGE
What Payment Or Coverage Pathways May Still Work With Divine?
Commercial Insurance With Out-Of-Network Benefits
Clients may pay Divine directly and receive a superbill for eligible PT services to submit for possible reimbursement. Clients are responsible for verifying out-of-network benefits, deductibles, referral or authorization requirements, and documentation requirements before the first session. Reimbursement is not guaranteed.
HSA/FSA
Eligible physical therapy expenses may generally qualify under applicable federal tax and plan rules. Clients should verify eligibility and documentation requirements with their own plan administrator.
Original Medicare
Divine is not enrolled as a Medicare provider. Medicare beneficiaries should contact Divine before scheduling so the requested service and appropriate pathway can be clarified.
Medicare Advantage, TRICARE, Medicaid, Workers' Compensation, Auto, And Other Third-Party Programs
These programs have separate enrollment, network, authorization, and billing requirements. Divine's NPI or commercial out-of-network status does not automatically establish eligibility. Coverage should be verified before care when third-party reimbursement is expected.
Services Medicare Never Covers, For Anyone
These sit outside Medicare's billing framework entirely, so a beneficiary may pay for them directly regardless of enrollment status. At Divine, that includes dry needling (statutorily non-covered); wellness-oriented visits such as an annual movement assessment or preventive movement screening where nothing is being treated; and sports performance or return-to-activity conditioning for someone who isn't currently injured. It does not include general fitness or maintenance exercise that would otherwise require a therapist's skilled judgment to be safe or effective for a diagnosed condition. That's typically Medicare-covered skilled maintenance therapy, not a private-pay service, and is exactly the kind of thing worth naming out loud on the discovery call rather than guessing at.
THE CLEAR CASES
What Can A Medicare Beneficiary Always Pay For Privately?
Services Medicare never covers. Medicare's billing rules govern covered care; services that are statutorily non-covered sit outside that framework, and a beneficiary may pay for them directly like anyone else. Dry needling is the clearest example at this practice (it is statutorily non-covered by Medicare), along with wellness-oriented services such as an annual movement assessment that isn't treatment of an illness or injury.
The line between "covered therapy service" and "non-covered service" is precisely where a careful conversation matters, because it is drawn by regulation rather than by what a session looks like. Where your situation falls, and what that means for care in your Stafford County or Fredericksburg home, including neurological and balance rehabilitation, where many Medicare-age clients start, is a question for the discovery call, not for a website's fine print.
BEFORE YOU SCHEDULE, HERE OR ANYWHERE
What Should You Ask Before Scheduling?
Two questions settle most of it.
01
Is the care I'm seeking a Medicare-covered physical therapy service, or something Medicare never covers?
02
What is this practice's Medicare enrollment status, and what does that mean for me specifically?
Any direct-pay practice should answer both in plain language before taking a dollar from a Medicare beneficiary, and this one will, on your complimentary discovery consultation.
If it turns out this practice cannot appropriately provide what you need, Dr. Paige will say so and point you toward a setting that can, the same honesty that governs referrals under Virginia's direct access rules, and every payment conversation on the Care & Investment page.
I spent years treating Medicare beneficiaries in hospital and inpatient rehabilitation settings, and I watched how much confusion this topic causes people who deserve better. So this is my commitment: if you have Medicare, tell me on the discovery call. I will explain exactly what applies to your situation before anything is scheduled, and if the right answer is a Medicare-enrolled clinic rather than my practice, you'll hear that from me directly.
Dr. Thea Paige, PT, DPT, CMTPT, PCES
BEFORE YOU SCHEDULE
The Medicare Conversation, In Three Steps.
01. Say the word "Medicare"
First thing, on the discovery call. It changes the rules that apply, so it should change the conversation.
02. Name The Service
Covered therapy for an injury or condition, or a non-covered service like dry needling or a wellness assessment? The distinction decides everything.
03. Get The Answer In Plain Language
What this practice can and cannot appropriately provide in your case, and a genuine pointer elsewhere if the answer is "not us."
BEFORE YOU CALL
Can Divine Physical Therapy See You If You Have Medicare?
A few quick questions can help you understand whether the service you are seeking may fit Divine Physical Therapy's current direct-pay model. Divine is not enrolled in Medicare, so Medicare-covered physical therapy is handled differently from commercial out-of-network care.
No Medicare coverage of any kind
These rules do not apply to you. Direct-pay care is available.
On Medicare, seeking treatment for an injury, illness, surgery recovery, pain or a condition
Not a fit. This is covered care, and a physical therapist cannot privately contract with you for it.
On Medicare, seeking skilled care to hold onto function with a chronic condition
Not a fit. Medicare covers skilled maintenance care — you should not be paying cash for it.
On Medicare, wanting fitness, conditioning, performance or wellness work with nothing being treated
Possible fit. Medicare does not cover this for anyone. Confirm on the call.
On Medicare, wanting a preventive movement screen with no current problem
Possible fit. Not a Medicare benefit. Confirm on the call.
On Medicare, asking about dry needling
Depends. Medicare does not pay for dry needling, but the rest of the visit matters. Ask before booking.
On a Medicare Advantage plan
No Medicare coverage of any kind
This tool is for general education only and does not create a provider–client relationship or make a coverage determination. Medicare and Medicare Advantage rules can change. Verify your benefits and contact Divine Physical Therapy before scheduling.
KEEP READING
Where To Go Next
Balance & Fall Prevention
Falls are not a normal part of getting older, and balance is measurable.
Coming Home From Inpatient Rehab
The gap between the hospital and the clinic, and what closes it.
Superbills & Out-Of-Network Reimbursement
Reimbursement process for commercial plans with superbills.
YOUR QUESTIONS, ANSWERED
