Does Medicare Cover Physical Therapy?
Key takeaways:
Medicare covers inpatient and outpatient physical therapy (PT) in a number of settings, including at your home and via telehealth.
Original Medicare and Medicare Advantage (MA) pay similarly for PT, but you may need to be more vigilant about getting coverage if you have MA.
If you get outpatient PT and have original Medicare, you can expect to pay 20% of the Medicare-allowed amount — unless you have supplemental insurance like Medigap to pick up the out-of-pocket costs.
Table of contents
Physical therapy (PT) can help you get better or feel better faster. A physical therapist and physical therapy assistants can help you:
Learn to walk again after a traumatic fall or injury
Address an aching joint so you may delay surgery, or recover from it more safely
Gain strength and improve balance if you have a medical condition that makes your muscles weak or uncoordinated
Depending on the setting, physical therapists may work with a team of related healthcare professionals, such as occupational therapists and speech therapists.
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Below, we break down how Medicare, Medicare Advantage (MA), and Medicare supplement insurance (Medigap) cover physical therapy.
Does Medicare cover inpatient and outpatient physical therapy?
Medicare pays for medically necessary physical therapy, whether you receive it in a hospital, physical therapy center, or your home.
Medicare enrollees have to work with their therapists, doctors, and sometimes Medicare service representatives to ensure coverage. But, in the end, Medicare often pays the bulk of costs.
Medicare physical therapy coverage in the hospital
If you have original Medicare, Part A will pay 100% of the PT bill after you’ve paid your $1,632 annual deductible in 2024. This includes coverage for physical therapy while in a:
Hospital or acute-care rehabilitation center
Skilled nursing facility
Or at home working with a private practice therapist or other Medicare-qualified therapy professional
Keep in mind that you must meet certain rules and requirements to receive coverage for services. This 100% coverage after the deductible is paid lasts for the first 60 days of inpatient services. Between days 60 and 90, Medicare charges you a daily coinsurance fee of $408. From day 91, you’ll pay $816 per each lifetime reserve day for coverage of up to 60 additional days. After that, Medicare will cover 100% of the cost per benefit period or episode of care.
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If you have a Medicare supplement (Medigap) plan, you will get a break on your out-of-pocket costs. That’s because all Medigap plans pay at least Part A hospital coinsurance that may apply, and many pay the deductible, as well.
Medicare Advantage plans pay for inpatient physical therapy, but you are likely to face coinsurance and copays. Unlike original Medicare, most MA plans limit which hospitals and skilled nursing facilities you can use to those that are in a network. You also are likely to need prior authorization. MA plans can make their own coverage rules, but they can’t be more restrictive than traditional Medicare. They also can’t charge enrollees more out of pocket for skilled nursing facility care.
Cost of physical therapy in an office, facility, and sometimes at home
Medicare Part B covers physical therapy in a doctor's or therapist's office, or at home if you are unable to travel.
Part B will pay 80% of the Medicare-approved amount after you pay your Part B deductible ($240 in 2024). You, your retiree health plan, Medicare supplement insurance, or Medicare Advantage plan pay the other 20%.
How many physical therapy sessions will Medicare pay for?
As long as your healthcare professional deems the skilled service of PT medically necessary, Medicare will continue to pay for it. But you can expect your care team to reassess your goals at regular intervals. There’s no longer an “improvement standard” that denies claims for care aimed at maintaining a patient’s condition instead of fully restoring function. Still, the patient must be deemed to require these skilled PT services to have them covered.
If you’re in a skilled nursing facility, Medicare allows up to 25% of physical therapy sessions to be conducted in a group if the therapist believes that a group setting is good for you. But the therapist can’t schedule a group session for their own convenience.
Physical therapy can be provided at home as long as it meets extensive Medicare standards. Prior to 2020, there were different rules for therapies given at home. Since then, there is broader coverage for physical, occupational, and speech therapies managed by home healthcare agencies.
Therapy professional organizations warn that some people continue to be denied therapy at home. They offer these consumer guidelines for people who need help getting at-home therapy.
Are there any situations when Medicare won’t cover physical therapy?
If you receive $2,330 in outpatient care in 2024, you've hit a limit. You can receive more physical therapy if your therapist can show that it is medically necessary.
Medicare has strict rules about who can provide PT and how much they can charge for it. The American Physical Therapy Association (APTA) and related professional organizations warn Medicare patients to beware of myths about limits in skilled nursing and home health settings and instead advocate for the Medicare-covered therapy they need.
In a situation where Medicare is unlikely to pay for physical therapy, a healthcare professional such as a physical therapist, doctor, or home health agency must give you a written statement called an Advance Beneficiary Notice of Noncoverage that explains why coverage isn’t expected, along with an estimate of costs. This is to alert you that you may have to pay the costs out of pocket if you choose to have therapy.
Do different Medicare Advantage plans have different levels of coverage for physical therapy?
Medicare Advantage plans may provide extra benefits compared with original Medicare. Recently, some private insurers’ MA plans have expanded their physical therapy coverage. You may find plans that offer personalized virtual musculoskeletal care and home-based physical therapy, for example. It’s part of a movement toward digital health and digital therapeutics.
At other times, you may need to advocate for coverage. A report from the U.S. Department of Health and Human Services found that of the prior authorization requests that Medicare Advantage plans denied, traditional Medicare likely would have approved 13% of them. Physical therapy was among the covered services that MA enrollees couldn’t access, the report found.
Can Medicare supplement insurance help cover the cost of physical therapy?
Medicare supplement insurance — or Medigap — helps cover out-of-pocket costs such as deductibles, copays, and coinsurance from Medicare Parts A and B. Medicare’s website allows you to compare the 10 standardized Medigap plans side by side.
As mentioned earlier, if you need inpatient physical therapy, you’re likely to have lower out-of-pocket costs, because all Medigap plans cover Part A coinsurance and most cover the deductible. More than half of Medigap plans pay the bills for coinsurance in a skilled nursing facility.
Every standardized Medigap plan except high-deductible plans K and L fully covers Part B copayments or coinsurance. So your outpatient PT costs stand a good chance of being covered, as well.
The Medigap plan you choose (or chose) as well as your health needs will determine to what extent your physical therapy costs are covered.
Does Medicare cover telehealth visits for physical therapy?
Medicare payments for telehealth visits were expanded during the COVID-19 pandemic to allow Medicare to pay for telehealth in more places and for more treatments. This includes PT for a wide range of services, ranging from gait training to management of orthotics and prostheses.
The American Medical Association (AMA) and other groups wanted Congress to further expand telehealth flexibilities. Temporary changes have recently been made, and the 2024 Proposed Rule released by the Centers for Medicare & Medicaid Services (CMS) has authorized telehealth coverage for services such as remote PT through December 31, 2024. Medicare Advantage plans may have expanded telehealth offerings.
Do you need a doctor’s referral or prescription to have Medicare cover physical therapy?
Since 2005, Medicare patients don’t need to have a referral or prescription to see a physical therapist, but they still must be “under the care of a physician.” All 50 states allow enrollees some sort of direct access to PT, but the rules differ.
Contact APTA or your state physical therapy association to find out which of the three access levels your state has and what that means for your care and coverage.
What will you pay for physical therapy out of pocket?
Medicare pays for physical therapy and its sister treatments as long as the therapist follows the rules and submits a plan for your care. Sometimes the coverage is 100%; sometimes it is less.
If you have original Medicare and get outpatient care, Part B will pay 80% of allowable costs after you pay the deductible. You will pay 20% — unless you have a Medicare supplement plan that picks up out-of-pocket costs.
If you have a Medicare Advantage plan, it is likely that you’ll pay coinsurance and copays.
If you’re denied payment or therapy, check with your care team first. Then contact Medicare or the State Health Insurance Assistance Program (SHIP) to get the help you need.
The bottom line
Physical therapy is an important treatment that Medicare pays for — sometimes in full — in the hospital, therapy offices, and at home. There is no limit to how much therapy you can receive, as long as the therapist can show that it is medically necessary. A Medicare supplement policy can help offset the out-of-pocket costs of physical therapy. Check with your care team, Medicare representatives, or a free SHIP counselor if you have questions about your PT charges or coverage.
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