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Does Medicare Cover Physical Therapy


Medicare coverage for physical therapy is available. In some cases, you’ll need physical therapy to get back on your feet. Whether you’re in an accident or you have a medical condition, therapy can improve the quality of life.

If a doctor says that physical therapy will improve your quality of life, you can consider it necessary. In the context below, we’ll go into detail about when Medicare coverage applies, how often coverage applies, and more details you need to know before starting treatment.

Does Medicare Pay for Physical Therapy?

Medicare covers physical therapy when medically necessary. When physical therapy happens during or after hospitalization, Part A covers it. Part B pays for outpatient or at-home physical therapy.

You may be responsible for part of the cost. You’ll obtain therapy in a hospital, skilled nursing facility, outpatient physical therapy center, or your home.

Part A provides coverage for inpatient physical therapy. If you’re in the hospital for at least three days, Part A also pays for therapy in a skilled nursing facility after discharge.

If your doctor prescribes physical therapy, and you haven’t stayed at the hospital, Part B will cover your therapy. Yet, deductibles and coinsurance will apply. So, be ready to pay a portion of the bills.

At-Home Physical Therapy and Medicare

If you qualify for home health benefits, Medicare will pay the full cost of physical therapy in your home.

You must:

  • Be under a doctor’s care
  • Improve or to maintain your current physical condition
  • Have your doctor must certify that you’re homebound

Also, Medicare pays a portion of the cost for Durable Medical Equipment used in your home therapy.

What are the Medicare Rules for Physical Therapy?

In the past, Medicare paid physical therapists based on the number of visits and the amount of time they spent with patients. To keep costs down and improve care, Medicare adopted a value-based approach to physical therapy. Therapy doctors are now paid based on a complex formula that considers several factors related to a patient’s needs.

Doctors can authorize up to 30 days of physical therapy at a time. But, if you need physical therapy beyond that 30 days, your doctor will need to re-authorize it.

How Many Physical Therapy Visits Does Medicare Allow?

Medicare had a cap on the number of sessions you could have in a year. But, these physical therapy limits are no longer active. You can have as much physical therapy as is medically necessary each year.

However, the threshold amount that Medicare pays for physical and speech therapy combined is $2,150 before reviewing a patient’s case to ensure medical necessity. Also, once a patient spends $2,150 on physical and speech therapy, providers add special billing codes to flag this amount.

Medicare and Physiotherapy

Physical therapy is known as “physiotherapy” in many parts of the world, including Canada, Europe, and Australia. Some physical therapy doctors in the U.S. may use the term “physiotherapy” to describe what they do. Medicare will cover your therapy, regardless of whether it is called physical therapy or physiotherapy.

Does Part C Cover Physical Therapy?

Advantage plans must cover the same as Medicare, or better. So, you can expect physical therapy to be part of the policy.

Still, costs can vary between plans. Further, you’ll need to stay in-network to obtain proper coverage.

If you anticipate needing physical therapy, consider choosing the policy that covers more than just a portion of the bill.

Further, you should know that physical therapy cuts to Medicare could impact access to care.

Medigap and Physical Therapy

When you have Medigap, the plan pays your portion of the coinsurance bill. Some plans even cover deductibles. Those that anticipate needing physical therapy should consider Medigap.

To better explain how Medigap could benefit someone in need of physical therapy I’m going to use Josie as an example.

Josie needs physical therapy for her knees. Well, she chose to go with Plan G because she knows her needs to frequently visit the doctor offices.

Since Josie has Plan G, she will pay her premium and the Part B deductible. If Josie has inpatient physical therapy, she won’t pay anything other than her monthly premium.

But, with outpatient physical therapy, Josie will pay the Part B deductible. If Josie didn’t have Medigap she could be responsible for deductibles and a portion of the bill.

FAQs

Do I need a referral for physical therapy under Medicare?
Medicare only pays for physical therapy if a doctor refers you. It won’t cover physical therapy if you’re not under a doctor’s care.
Does Medicare cover physical therapy for back pain?
Medicare covers necessary physical therapy to help you manage back pain. Unless you’ve recently been hospitalized, Part B will pay for therapy.
Does Medicare cover transportation to a physical therapist?
Medicare doesn’t cover non-emergency transportation to doctors. But, some Part C plans may include transportation benefits.
Does Medicare cover aquatic physical therapy?
If you would benefit from aquatic physical therapy, Medicare covers it. You must use doctors that accept Medicare assignment.
Does Medicare cover occupational therapy?
Medicare covers occupational therapy in the same way it covers physical therapy. Also, there is coverage for speech therapy.
Does Medicare provide coverage for CORF care?
Medicare covers services at Comprehensive Outpatient Rehabilitation Facilities (CORFs), including physical and occupational therapy.

How to Get Help Paying for Physical Therapy with Medicare

Physical therapy can make a huge difference in your healing process after an injury or illness. And, it can help you manage chronic health issues. Our agents know the benefits of having quality coverage. To find the most suitable plan option for you, give us a call at the number above today! You can get a rate from all the top carriers in your area and choose for yourself the best match. Fill out an online rate form to start now!

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

11 thoughts on “Does Medicare Cover Physical Therapy

  1. Hi Jagger, if I rec’d a denial from Medicare for PT benefit max can I appeal with GP KX modifier? I am confused if there is no cap why they are getting denied.
    I pray you answer. Have a great day

    1. Hi Stephanie, please talk to your physician. The maximum amount is only for the purpose of evaluating medical necessity.

  2. I was told by the nurse practitioner at my Orthopedic doctor’s office that Medicare requires I attend doctor prescribed outpatient physical therapy for my back pain before I could have an MRI to check further the cause of my back pain. If this is true, can you tell me how many PT sessions I must attend before I qualify to have an MRI administered to me by my Orthopedic doctor?

    1. Hi Sydney – we would recommend asking your doctor themselves about this. However, it is usually the other way around and some patients are told to have MRIs before attending physical therapy.

  3. Hello Jagger,
    I’m a Part B provider for PT and OT. What’s the limit for PT and OT for 2021 that Medicare will cover.

    Thanks,

    Christine

    1. Hi Christine, thank you for your question. There is no limit as long as the services are medically necessary. However, there is a threshold for review once a patient reaches $2,110 for physical therapy and speech language pathology services combined. There is also a separate $2,110 threshold for review for occupational therapy. These amounts are subject to change each year.

    1. Hi Jane, most of the time, you will owe a $20 copay for office visits with Plan N. However, whether you owe the copay will depend on the billing code for your service.

  4. I fell just over 2 months ago. I broke 5 vertebrae and had a kyphoplasty on the 3 that needed them. I still had persistent pain and the MRI of my lumbar spine showed significant arthritis just below my kyphpplasty done to L1.
    I can’t take NSAIDS because of my Crohn’s disease.and a month of physical therapy has not improved it.
    My doctor wants to continue with medial lumbar injections. I was told that pre authorization and upon investigating this found that they would not approve until I have a record of pain for 3 months.

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