Medicare Physical Therapy Coverage
- Medicare does cover physical therapy in certain situations. Find out how and when it’s covered, and learn what sort of restrictions may apply.
Several different types of therapy are covered under Medicare, and among these is physical therapy. In this guide, we’ take a look at how Medicare covers physical therapy and how much Medicare pays for physical therapy when ordered by your doctor.
Medicare Part B, Part A and Medicare Advantage Plans Cover Physical Therapy
Outpatient physical therapy is typically covered by Medicare Part B. Physical therapy patients with Part B will be responsible for meeting their annual Part B deductible ($198 per year in 2020) along with a 20% coinsurance payment for any remaining costs.
Outpatient physical therapy may be performed in:
- Medical offices
- Physical therapists offices
- Hospital outpatient centers
- Rehabilitation centers
- Skilled nursing facilities
- At home (see below)
Inpatient physical therapy may be covered under Medicare Part A. Inpatient physical therapy is performed at hospitals, mental health facilities, skilled nursing facilities and rehabilitation centers. Your costs for inpatient physical therapy will typically be built into the inpatient deductible that you are responsible for under Medicare Part A.
Both inpatient and outpatient physical therapy are also covered by Medicare Part C plans, which are also known as Medicare Advantage. These plans include all of the same coverage as Part A and Part B in addition to typically having some extra benefits. The deductibles and coinsurance for these plans will vary.
When Does Medicare Pay for Physical Therapy?
In order for physical therapy to qualify for Medicare coverage, it must be considered medically necessary. That means the treatment must be for one of the following reasons:
- To improve your current condition
- To maintain your current condition
- To slow any further deterioration of your condition
Your physical therapy must also be performed by a qualified professional such as a physical therapist or doctor.
There is no annual limit on the physical therapy costs that Medicare may cover. However, once a certain threshold of spending is reached, the physical therapist must confirm that the services remain medically necessary to treat your condition. In 2020, that threshold is $2,080 and is subject to change each year.
In order to show that the treatment is medically necessary, your physical therapist will document:
- Your diagnosis
- Type of physical therapy you’ll be receiving
- Long-term goals of the physical therapy
- Number of physical therapy sessions you’ll receive in a day or week
- Total number of physical therapy sessions needed
If physical therapy claims exceed $3,000 within a calendar year, a targeted medical review may be required.
Medicare Covers At-Home Physical Therapy
- You are under the care of a doctor and your physical therapy is part of the care plan.
- You are certified homebound by a doctor.
- The physical therapy is administered by a qualified physical therapist.
- The home health agency providing the service is certified by Medicare.
- The doctor believes your condition can be reasonably expected to improve with physical therapy or that physical therapy is needed to maintain your condition.
What is Physical Therapy?
Physical therapy is a service that optimizes quality of life by utilizing prescribed physical exercise, hands-on care and patient education. Physical therapists may work in hospitals, hospice centers, rehabilitation facilities, doctor’s offices, fitness centers and private physical therapy practices.
Physical therapy is used to treat patients following injuries, surgeries, neurological episodes such as strokes and patients who are experiencing chronic pain, discomfort and arthritis. Not all physical therapists are the same. Many tend to specialize in one or more specific areas and types of physical therapy.
Physical therapy treatment can involve stretching, exercising, the use of equipment like walkers and more.
Does Medicare Cover Other Types of Therapy?
Medicare covers many other types of therapy in addition to physical therapy.
- Occupational therapy
- Speech-language pathology
- Radiation therapy
- Cardiovascular behavioral therapy
- Nutrition therapy
- Obesity behavioral therapy
- Hyperbaric oxygen therapy
- Mental health therapy and counseling
If you have more questions about Medicare physical therapy coverage, you can speak with your doctor or call 1-800-MEDICARE (1-800-633-4227). If you are enrolled in a Medicare Advantage plan, you may contact your plan carrier directly to ask about how physical therapy is covered by your plan.