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.

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.

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.

Doctor’s services you receive while in an inpatient physical therapy facility are paid by Medicare Part B.

Medicare Part B medical insurance covers 80% of the costs of medically necessary outpatient physical therapy after you’ve met your Part B deductible — $240 in 2024. You are responsible for 20% of the Medicare-approved outpatient service amount.

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.

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.

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.

Since 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.