You may wonder if your Medicare coverage includes physical therapy. Luckily, Medicare coverage for physical therapy is available when a physician recommends it.
You will need physical therapy to get back on your feet in some cases. Whether you are in an accident or have a medical condition, physical therapy can improve your quality of life.
Medicare will cover the treatment if a doctor says that physical therapy is medically necessary after surgery or to treat a condition. Below, we will review when Medicare coverage applies, how often coverage applies, and what you should know before starting physical therapy treatment with Medicare.
Does Medicare Pay for Physical Therapy?
Medicare covers physical therapy when a physician deems it medically necessary. When physical therapy happens during or after hospitalization, Medicare Part A covers the cost. On the other hand, Part B of Medicare pays for outpatient or at-home physical therapy.
If you obtain physical therapy in a hospital, skilled nursing facility, outpatient physical therapy center, or home, you may be responsible for part of the cost.
Medicare Part A provides coverage for inpatient physical therapy. Medicare Part A will also pay for therapy in a skilled nursing facility after discharge if you are in the hospital for at least three days.
If your doctor prescribes physical therapy and you have not stayed at the hospital, Medicare Part B will cover the costs. However, deductibles and coinsurance still apply. So, be ready to pay a portion of the bills.
At-Home Physical Therapy and Medicare
If you qualify for home health benefits, you can have Medicare cover physical therapy at your home in full.
- Be under a doctor’s care
- Improve or maintain your current physical condition
- Have your doctor certify that you are homebound
In addition to in-home physical therapy, Medicare also pays a portion of the cost for durable medical equipment used during treatment.
What are the Medicare Rules for Physical Therapy?
In the past, Medicare paid physical therapists based on the number of visits and time spent with patients. Since then, Medicare adopted a value-based approach to physical therapy to keep costs down and improve care. Physical therapy doctors are now paid based on a complex formula that considers several patients’ needs factors.
Doctors can authorize up to 30 days of physical therapy at a time. But, if you need physical therapy beyond those 30 days, your doctor must re-authorize it.
Medicare Physical Therapy Cap 2022
Until recently, Medicare had a cap on the number of physical therapy sessions you can have in a year. However, Medicare no longer enforces these physical therapy limits. Thus, 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. Once you meet this threshold, Medicare will still cover physical therapy services. However, they must be billed with unique codes to prove medical necessity.
Does Medicare Cover Physiotherapy?
Physiotherapy is another term for physical therapy in many parts of the world, including Canada, Europe, and Australia. Some physical therapy doctors in the U.S. may use physiotherapy to describe what they do. If this is the case, Medicare will cover your therapy, whether it is called physical therapy or physiotherapy.
Medicare Part C and Physical Therapy
Medicare Part C or Medicare Advantage plans cover the same benefits as Original Medicare or better. So, you can expect Medicare Advantage to cover physical therapy.
When you enroll in a Medicare Advantage plan, cost-sharing expenses can vary between plans. Additionally, you will need to stay in-network to obtain proper coverage at the lowest cost.
Medicare Supplement Plans and Physical Therapy
Your Medicare Supplement (Medigap) policy could cover your out-of-pocket physician therapy costs. Depending on the Medicare Supplement plan, you could receive full coverage. Those who anticipate needing physical therapy should consider Medigap to keep their costs as low as possible.
To better explain how Medigap could benefit someone in need of physical therapy, let’s look at an example. Suppose Josie needs physical therapy for her knees. She enrolled in Medicare Supplement Plan G because she knows she needs to visit the doctor’s office frequently.
Since Josie has Medigap Plan G, she will pay her premium and the Medicare Part B deductible. If Josie has inpatient physical therapy, she will not pay anything other than her monthly premium.
But, with outpatient physical therapy, Josie will need to pay the Medicare Part B deductible. If Josie did not have Medigap, she could be responsible for deductibles and coinsurance.
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. At MedicareFAQ, our agents understand the importance of having quality coverage.
To find the most suitable plan option for you, call us at the number above today! You can get a rate from all the top carriers in your area and find the best match. Fill out an online rate form to start now.
- Therapy Services, CMS. Accessed April 2022.
- Physical Therapy, Medicare. Accessed April 2022.