Does Medicare Cover Physical Therapy?Medicare will pay for your physical therapy if your doctor decides it is medically necessary to treat your injury or illness. Physical therapy is covered under Medicare whether it is as an inpatient, outpatient or at home. Medicare Part B does not limit how much it will pay for outpatient physical therapy in a given year. Show
Fact Checked Our fact-checking process starts with vetting all sources to ensure they are authoritative and relevant. Then we verify the facts with original reports published by those sources, or we confirm the facts with qualified experts. For full transparency, we clearly identify our sources in a list at the bottom of each page. Cite Us APA Turner, T. (2022, November 3). Does Medicare Cover Physical Therapy? RetireGuide.com. Retrieved November 22, 2022, from https://www.retireguide.com/medicare/treatments/pain-management/physical-therapy/ MLA Turner, Terry. "Does Medicare Cover Physical Therapy?" RetireGuide.com, 3 Nov 2022, https://www.retireguide.com/medicare/treatments/pain-management/physical-therapy/. Chicago Turner, Terry. "Does Medicare Cover Physical Therapy?" RetireGuide.com. Last modified November 3, 2022. https://www.retireguide.com/medicare/treatments/pain-management/physical-therapy/. Why Trust RetireGuide.com Content created by RetireGuide and sponsored by our partners. Key PrinciplesRetireGuide’s mission is to provide seniors with resources that will help them reach important financial decisions that affect their retirement. Our goal is to arm our readers with knowledge that will lead to a healthy and financially sound retirement. We’re dedicated to providing thoroughly researched Medicare information that guides you toward making the best possible health decisions for you and your family. RetireGuide LLC has partnerships with Senior Market Sales (SMS) and GoHealth. Our partners are able to be reached through the phone numbers and/or forms provided on our website. The content and tools created by RetireGuide adhere to strict Medicare and editorial guidelines to ensure quality and transparency. Editorial IndependenceWhile the experts from our partners are available to help you navigate various Medicare plans, RetireGuide retains complete editorial control over the information it publishes. We operate independently from our partners, which allows the award-winning RetireGuide team to provide you with unbiased information. Visitors can trust our inflexibility regarding our editorial autonomy. We do not allow our partnership to influence RetireGuide’s editorial content whatsoever. Key Takeaways
When Does Medicare Cover Physical Therapy?Physical therapy, sometimes called PT, uses specially designed equipment and exercises to help you regain or improve your previous physical abilities. Physical therapists are specially trained health care professionals who use massage, heat treatments and exercise to relieve pain and treat injuries, diseases or physical deformity in patients. Medicare covers part of the cost of your physical therapy only if your doctor determines that the treatment is medically reasonable and necessary. If the treatment is recommended by a physical therapist, but not ordered by a doctor, Medicare will not pay. A physical therapist or other therapy provider must give you a written notice called an “Advance Beneficiary Notice of Noncoverage” if your therapy is not medically necessary. This will let you know that Medicare will not cover physical therapy in your case. You will be required to pay the full cost. Tip If you have questions about whether your physical therapy will be covered, or what your costs may be, you can call Medicare at 1-800-633-4227 (TTY users can call 1-877-486-2048). You can also call your State Health Insurance Assistance Program (SHIP) for free, personalized health insurance counseling. Source: U.S. Centers for Medicare & Medicaid Services Medicare Coverage for Inpatient Physical TherapyMedicare Part A covers medically necessary inpatient physical therapy at inpatient rehabilitation facilities — sometimes called an inpatient “rehab” facility (IRF), acute care rehabilitation center or rehabilitation hospital. You will still be responsible for a deductible, coinsurance and copayments. Your Costs When Medicare Covers Physical Therapy 2023 Days 1 to 60 $1,600 deductible (unless you’ve already met your deductible in this benefit period.)Days 61 to 90 Days 91 and beyond $800 coinsurance for each “lifetime reserve day.” You have 60 of these over your lifetime.Each Day After Your Lifetime Reserve Days You will be responsible for all costs.Your doctor may order inpatient rehabilitation to help you recover from a serious injury such as a fall or accident or for a serious illness such as Parkinson’s disease that requires an intensive rehabilitation therapy program. Inpatient Physical Therapy Costs Medicare Covers
Doctor’s services you receive while in an inpatient physical therapy facility are paid by Medicare Part B. Medicare Coverage for Outpatient Physical TherapyMedicare Part B medical insurance covers 80% of the costs of medically necessary outpatient physical therapy after you’ve met your Part B deductible — $226 in 2023. You are responsible for 20% of the Medicare-approved outpatient service amount. Where Medicare Covers Outpatient Physical Therapy Services
In the past, Medicare Part B had a cap on how much it would pay each year for your outpatient physical therapy. The agency eliminated the cap in 2018. There is no longer any limit on how much it will pay for medically necessary outpatient PT under Medicare Part B. This may be different if you have a Medicare Advantage plan. Medicare Advantage plans are sold and administered by private insurers. You may be limited to using physical therapists and facilities within your Medicare Advantage plan’s network. Check your plan’s coverage rules regarding physical therapy services. Have you selected your 2023 Medicare plan? Maximize your Medicare savings with a plan from GoHealth. Annual Enrollment is open until December 7th. Does Medicare Cover In-Home Physical Therapy?Medicare Part B medical insurance will cover at home physical therapy from certain providers including private practice therapists and certain home health care providers. If you qualify, your costs are $0 for home health physical therapy services. But you will pay 20% of the Medicare-approved amount for durable medical equipment — wheelchairs, walkers and other such medical devices and equipment. You have to have Medicare Part A and/or Part B and meet all items on a list of requirements from Medicare to be eligible for at home therapy. Medicare Eligibility for Home Physical Therapy Coverage
You are not eligible for home PT services if you need more than part-time skilled nursing care. You may still get home services if you attend adult day care. You may still be considered homebound even if you leave home for medical treatment or short, rare nonmedical reasons such as attending religious services. Medicare Advantage and Medigap Physical Therapy CoverageSince Medicare Advantage plans are required to cover everything Original Medicare covers, your plan should at least cover what Medicare Part A and Part B covers for physical therapy. You should ask your plan administrator if your Medicare Advantage plan provides additional physical therapy coverage. Some plans may offer dental, vision, or fitness plans in addition to physical therapy. You may want to consider a Medicare Supplement plan (Medigap) if you are worried about out-of-pocket costs for PT. Medigap policies can help with copayments. Be aware, you cannot buy both a Medicare Advantage plan and a Medigap plan. You are limited to one or the other. Last Modified: November 3, 2022 7 Cited Research Articles
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