Does Medicare Cover Physical Therapy?

• by Christian Worstell
• February 23, 2021
• Reviewed by John Krahnert

Medicare Part B typically does cover physical therapy if it is considered medically necessary by a doctor or therapist.

Medicare Advantage (Medicare Part C) plans can also cover physical therapy, and some plans may offer additional benefits that Original Medicare (Part A and Part B) doesn't cover.

How much does Medicare pay for physical therapy?

Medicare Part B will typically pay 80% of the approved cost amount, and you will pay 20% after you meet your Part B deductible ($203 per year in 2021). If your physical therapy is not considered medically necessary, you're responsible for 100% of the cost.

To find out how much your physical therapy services will likely cost, speak with your therapist or therapy provider before receiving services.

Is there a limit on what Medicare pays for physical therapy?

In 2018, congress eliminated the limits on how much Medicare pays for therapy services in a single year.

This means that in qualifying cases, Medicare Part B will continue to help cover some of the costs of your physical therapy, no matter how high your accumulated costs grow in the year.

Your therapy provider may need to add a notation to your therapy claim, confirming that your therapy services are reasonable and necessary. Your therapist may also add information to your medical records explaining why the services are medically necessary.

If your physical therapy services are not medically necessary, your therapy provider must provide you with a written notice before providing services.

Who can receive physical therapy that is covered by Medicare?

Physical therapy services are generally covered for anyone with Medicare Part B, as long as the services are considered medically necessary.

Do I need a referral for physical therapy under Medicare?

In most cases, a referral is not needed to visit a physical therapist for an evaluation in order to determine if therapy is considered medically necessary.

If your physical therapy is considered medically necessary, you must then be under the care of a doctor who accepts Medicare assignment in order for the service to be covered by Medicare without facing excess charges.

Does Medicare cover in-home physical therapy?

Original Medicare may cover physical therapy performed in your home under Medicare’s home health benefits.

In order for in-home physical therapy to be covered by Medicare, the following circumstances typically must be met:

• You must be under the care of a doctor, and the therapy must be part of the doctor’s care plan. 
• Your doctor must certify that you are homebound.
• Your physical therapy treatments must be performed by a qualified physical therapist. 
• The agency providing your therapy services must be certified by Medicare. 
• Your doctor believes your condition can improve with physical therapy or that physical therapy is needed in order to maintain your condition. 

Does Medicare cover occupational therapy?

Medicare Part B provides coverage for occupational therapy on an outpatient basis.

The Part B deductible applies, and you will owe up to 20% of the Medicare-approved amount after you meet your annual Part B deductible. 

6 ways that physical therapy can help seniors

There are several reasons why a senior citizen might undergo physical therapy, such as:

1. Recovering from a fall, accident or stroke
   Falls are the most common type of accident for seniors, and they often result in broken bones and other injuries. Physical therapy can help you recover from a fall and regain strength in your affected body part.
   
   Seniors who suffer a stroke are also often left with one weaker hand or arm. As with recovering from a broken bone, physical therapy can help you rebuild strength and range of motion in your affected limbs.

2. Recovering from a surgery
   Many older adults find themselves confined to bed for weeks after undergoing surgery. After an initial resting period, physical therapy helps many recovering seniors regain the strength and range of motion that they enjoyed before their procedure.

3. Avoiding surgery
   A person may be able to avoid having surgery altogether by successfully rehabilitating an injury through physical therapy, if their doctor agrees to this treatment option.

4. Alleviating chronic pain
   Physical therapy can be an effective form of pain relief for chronic pain conditions such as arthritis and osteoporosis.

5. Reducing dependence on prescription medications
   Finding pain relief through physical therapy can reduce or eliminate one’s dependency on pain killing medication.

6. Combating Alzheimer’s disease
   Exercise, including physical therapy, can help slow down the effects of Alzheimer’s disease by increasing blood flow to the brain and tempering depression and mood swings.

Physical therapy can help seniors develop strength, flexibility and endurance, which are especially helpful in helping prevent falls and keeping seniors healthy and happy overall.

Common types of physical therapy for seniors

Because there are so many different reasons for going through physical therapy, there are several different types of therapy that can match each unique need.

Depending on your situation, your doctor may recommend one of the following types of physical therapy.

• Orthopedic physical therapy targets injuries to bones, muscles, ligaments and tendons.  
  
  
• Geriatric physical therapy is designed to address age-related conditions such as arthritis, Alzheimer’s or hip replacement recovery.
  
  
• Neurological physical therapy can assist with neurological disorders such as brain injuries, strokes, Parkinson’s disease, multiple sclerosis, cerebral palsy and Alzheimer’s.
  
  
• Cardiovascular or pulmonary rehabilitation aids seniors with heart and lung disorders.
  
  
• Wound care therapy can help a wound properly heal by promoting adequate oxygen and blood flow.
  
  
• Vestibular therapy is used to treat balance problems that can arise from inner ear infections or other problems affecting one’s equilibrium.
  
  
• Decongestive therapy works to drain built-up fluid in patients with lymphedema and other conditions.
  
  
• Pelvic floor rehabilitation aims to treat complications in the digestive system along with pelvic pain resulting from injuries, surgery or other conditions.

As there are different types of physical therapy, there are also a number of different methods that may be used to deliver therapeutic treatment.

Some of the physical therapy methods used to treat seniors include:

• Physical manipulation such as stretching, walking and range of motion exercises.
  
  
• Ultrasounds to promote blood flow and the heating of muscles, tendons and tissues.
  
  
• Phonophoresis, which is a method of helping deliver topical medications such as steroids to reduce inflammation.
  
  
• Electrical stimulation, which reduces pain and improves function through the use of topical electrodes on the skin.
  
  
• Hot, cold and moist pressure therapy.
  
  
• Light therapy, in which special lights and lasers are used.
  
  
• Patient education about body mechanics and movements.
  
  
• Massage therapy.
  
  
• Hydrotherapy, which uses water to treat soft tissue and improve circulation.

Do Medicare Advantage plans cover physical therapy?

Medicare Advantage plans (Medicare Part C) are sold by private insurance companies and combine the benefits covered by Medicare Part A and Part B into one single plan.

This means that Medicare Advantage plans will cover your physical therapy services that would qualify for Medicare Part B coverage as listed above.

Many Medicare Advantage plans may also provide benefits that aren’t covered by Original Medicare. Some of these additional benefits can include prescription drug coverage and membership to fitness and wellness programs such as Silver Sneakers.

To learn more about Medicare Advantage plans in your area that cover physical therapy, call today to speak with a licensed insurance agent.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

This article is for informational purposes only. It is not healthcare advice. Speak to your doctor or healthcare provider about your specific healthcare needs.