Welcome! We are so happy to have the opportunity to meet you and your child
Please reference the following information regarding insurance questions.
What insurance do you have?
If you have an HMO plan (We are ONLY contracted with Dignity Health (formerly Physician’s Medical Group)
- Please have your Primary Care Physician submit an referral request for an evaluation.
- Once we receive the referral we will contact you for scheduling.
If you have a PPO plan*
- Please have your child’s pediatrician send a referral and any medical records pertaining to the referral to our office.
- Please refer to the questions in the box below when calling your insurance company, verifying if therapy is a covered benefit and what your out-of-pocket expense would be.
- You will be paying Pediatric Therapy Center at the time of service, and billing your insurance for reimbursement.
*Reminder: We do not bill your insurance company for your child’s therapy. You will receive an invoice stating diagnostic and procedure codes. You will be able to use that invoice when submitting your claim to your insurance company.
If you have insurance coverage through Kaiser
- Please let your service coordinator know you would like to receive services through Pediatric Therapy Center. If approved Kaiser will email the authorization information to our office.
If you have Central Coast Alliance for Health (CCAH)
- Please have your Primary Care Physician send a referral authorization form (RAF) to Pediatric Therapy Center.
- Once we receive the referral (RAF) at our office, we will be contacting you for scheduling.
Questions for your Insurance Carrier
When talking to your insurance company, be sure to take notes and get the name and extension of whom you are talking to.
- Under what conditions are Occupational and/or Physical therapy covered under your plan? What types of conditions/diagnosis are excluded? My child’s Doctor has stated this diagnosis:____________________________.
- Please give the diagnosis to your insurance to be sure it is covered under your plan. My child is recommended to receive Speech, Occupational and/or Physical therapy so what do I need to proceed with services? Be sure to get a Pediatrician’s prescription.
- I am interested in a provider who is “out of network”. How do I obtain those services and get “in network rates”? (As there are no other Pediatric Therapy specialists in my area.)
- I have spoken to a pediatric outpatient practice that has suggested these possible procedural codes for my child. Are they covered under the plan?
- Do I have a deductible?
- Are there any limitations or exclusions under my plan for therapy?
- Let your insurance know that you, as the member, will be billing them for reimbursement and what is the process?
If any further questions come up when speaking to your insurance company, do not hesitate to call us for further information or support.
Evaluation CPT Codes
Treatment CPT Codes
97165 / 97166 / 97167 / 96111
97110 / 97112 / 97530 / 97535
97001 & 96111
97110 & 97112
Forms for new clients who have a scheduled evaluation
Once you are scheduled for an appointment at our center please fill out the necessary online forms for the evaluation appointment.
Thank you and we look forward to meeting you!
General questions on the evaluation process
Please Contact our Main Office at (831) 684-1804
Kelly Morgan - Office Assistant
Available Monday, Wednesday, and Friday
For specific questions related to your insurance, questions about treatment sessions and more details on PTC programs
Please Contact via Phone at (831) 684-1804 ext. 0 or email at firstname.lastname@example.org
Keri Allen, MOT, OTR/L - Director of Services