Does Medicare Cover Physical Therapy?

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 ($198 per year in 2020). 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. 

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!