Does Medicare Cover Physical Therapy?
Original Medicare will pay for your physical therapy if your doctor decides it is medically necessary to treat your injury or illness. Medicare may also help cover physical therapy you get through home health care. Medicare does not limit how much it will pay for physical therapy in a given year.
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 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.
Medicare Coverage for Inpatient Physical Therapy
Medicare 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.
- Days 1 to 60
- $1,364 deductible (unless you’ve already met your deductible in this benefit period)
- Days 61 to 90
- $341 coinsurance each day
- Days 91 and beyond
- $682 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.
- A semi-private room
- Nursing services
- Physical therapy services
- Other hospital services and supplies
Doctor’s services you receive while in an inpatient physical therapy facility are paid by Medicare Part B.
Medicare Coverage for Outpatient Physical Therapy
Medicare Part B medical insurance covers 80 percent of the costs of medically necessary outpatient physical therapy after you’ve met your Part B deductible — $198 in 2020. You are responsible for 20 percent of the Medicare-approved outpatient service amount.
- Comprehensive outpatient rehabilitation facilities
- Medical offices
- Offices of privately practicing physical therapists
- Outpatient departments in general hospitals or critical access hospitals
- Rehabilitation agencies, sometimes called other rehabilitation facilities (ORFs)
- Skilled nursing facilities when Medicare Part A doesn’t apply
- At home in some cases
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.
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 percent 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.
- You must be under the care of a doctor.
- You must have a plan of care your doctor created and regularly reviews.
A doctor must certify that you need one or more of these:
- Intermittent skilled nursing care other than drawing blood.
- Physical therapy scheduled over a reasonable time frame that is specific, safe and effective treatment for your condition by a Medicare-approved provider.
- That you are homebound.
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 Coverage
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.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, June). Medicare Coverage of Therapy Services. Retrieved from https://www.medicare.gov/Pubs/pdf/10988-Medicare-Limits-Therapy-Services.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Physical Therapy. Retrieved from https://www.medicare.gov/coverage/physical-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Inpatient Rehabilitation Care. Retrieved from https://www.medicare.gov/coverage/inpatient-rehabilitation-care
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Home Health Services. Retrieved from https://www.medicare.gov/coverage/home-health-services
- AARP. (n.d.). Does Medicare Cover Physical Therapy? Retrieved from https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-physical-therapy/