Athletic Trainers as Outpatient Rehabilitation Providers: An Analysis of Role, Value, and Insurance Reimbursement in a Large Academic Health Care System.

Context: Athletic trainers (ATs) are health care professionals who provide care across multiple settings, including outpatient rehabilitation. Given the increase in health care utilization in the general population, ATs may provide necessary rehabilitation services to treat common musculoskeletal conditions. Objective: Describe patient populations, conditions, health care utilization, and billing practices of ATs practicing in an outpatient orthopaedic setting from January 2010 to December 2024. Design: Retrospective cohort study. Setting: University-based health care system. Patients and Other Participants: Patients in outpatient orthopaedic rehabilitation. Main Outcome Measures: Episode of care (EOC) data were extracted from health insurance claims. Median and interquartile range (IQR) were reported for patient age, number of visits per EOC, current procedural terminology (CPT) codes billed, and charges per visit. Diagnoses associated with the EOC were by injury category, nature of injury, and body region categories using International Classification of Disease version 9/10 codes. Frequencies, proportions, and 95% CIs were reported for injury category, nature of injury, body region, and surgical cases. Results: Athletic trainers were primary providers for 7789 EOCs. Median patient age was 37 years (IQR: 19, 51), with the majority of patients being female (4189; 54%, 95% CI = 53%, 55%). The knee and shoulder were the most common body regions treated (knee: 2993, 26%, 95% CI = 25%, 27%; shoulder: 1863, 16%, 95% CI = 15%, 17%). Seventeen percent of EOCs indicated the presence of a surgical procedure. Episodes of care comprised a median number of 3 visits (IQR: 2, 6) with 6 median CPT codes (IQR: 2, 6) billed, resulting in median EOC charges of $1291 (IQR: $782, $2099). Episodes of care that were isolated to the inclusion of AT-billable procedural codes resulted in $13.5 million in charges and $10.8 million in reimbursements over 15 years. Conclusions: Athletic trainers provided primary rehabilitative care for common musculoskeletal conditions, particularly of the knee and shoulder. Similar billing practices as other allied health professionals were observed based on CPT codes billed and median charges per visit.