Does Medicare Cover Physical Therapy?

Here’s how Original Medicare (Parts A and B) covers physical therapy:

Part A covers Medicare physical therapy when you receive inpatient services. This care is often called rehabilitative. Medicare physical therapy guidelines state that, for Part A to cover this type of physical therapy, a doctor must certify that intensive inpatient rehabilitation is medically necessary and coordinated and supervised.

Part B generally provides Medicare physical therapy for outpatient services that are deemed medically necessary. You visit your doctor or provider with outpatient care to receive your services, but they don’t require an overnight stay at a hospital. You may also be able to receive your therapy at home.

The answer depends on if your care is inpatient or outpatient. Inpatient means you’re admitted to a hospital and stay overnight. With outpatient service, you leave the facility after you’re finished.

If you need inpatient physical therapy, Medicare Part A covers the first 60 days of care after you’ve reached your deductible. How much you’ll pay increases with time, though. Here’s how much you’ll need to pay in 2022 for inpatient physical therapy:

• Days 1-60: $0 after you reach your deductible.
• Days 61-90: $389 daily coinsurance.
• Day 91 and beyond: $778 daily coinsurance. These days are called Lifetime Reserve Days, and you have 60 over your lifetime.
• After 60 lifetime reserve days: You pay all costs.

Part B doesn’t count days when covering outpatient physical therapy. When received as outpatient care, Medicare and physical therapy work like many other services you may receive. Your Part A deductible will apply until it’s met. After that, you’ll pay 20% coinsurance for the Medicare-approved physical therapy services you receive.

Many Original Medicare beneficiaries also enroll in Medicare Supplement Insurance (Medigap) to help cover the out-of-pocket costs that can come with Part A. Depending on where you live, these can include coinsurance, copayments and your deductible.

Medicare Part B typically pays 80% of Medicare-approved therapy costs when it’s medically necessary. You’ll pay the remaining 20% or coinsurance.

So, how much does physical therapy cost? It depends on the services you need and whether Medicare covers them. Your doctor or therapist is required to let you know in writing if any of your therapy services aren’t medically necessary. If you choose to receive them anyway, you may have to pay full price.

Do I need a referral for physical therapy under Medicare?

Your physical therapy needs to be certified as medically necessary by your doctor for it to be covered by Medicare Part B.

That means a referral to a specialist to help with general fitness probably won’t be covered by Medicare. Generally, your physical therapy must improve or maintain a health condition or keep it from deteriorating.

Also, Medicare physical therapy guidelines require that treatments are provided by a qualified therapist or doctor, who will coordinate your care with your doctor. You have flexibility in where you can receive outpatient physical therapy that Medicare Part B covers:

• Private provider offices
• Hospital (including critical access hospitals) outpatient departments
• Skilled Nursing Facilities (SNF) when Part A isn’t involved because the therapy isn’t inpatient
• Other Rehabilitation Facilities (ORF) and Comprehensive Outpatient Rehabilitation Facilities (CORF)
• At home from a qualified therapist

There’s no longer a Medicare physical therapy cap for what’s covered; once you’ve met your Part B deductible, Medicare will pay 80 percent of your physical therapy costs. You’ll be responsible for paying the remaining 20 percent.

To make sure your care is medically necessary, Medicare does apply a limit in 2022 of $2,150 per year — this is what Medicare will pay for physical therapy and speech-language pathology (SLP) combined. Any amount above this limit must be confirmed by your provider as necessary. You’ll see this designation called the KX Modifier. Once you reach $3,000, your care will be subject to medical review in order for Medicare to continue its coverage.

Does Medicaid cover physical therapy?

This depends on where you live. Medicaid is separate from Medicare — it’s health insurance for limited-income children, adults, and families partially run by the states. Each state offers different Medicaid services. To see if you have access to physical therapy that accepts Medicaid, contact your local Medicaid office.

Medicare coverage for physical therapy

To recap: Does Medicare cover physical therapy? Yes, but how comes down to the type of physical therapy you need and where you receive it.

Part A: covers inpatient rehabilitation and other medically necessary services needed after hospitalization.

Part B: covers medically necessary outpatient physical therapy typically somewhere other than the hospital (unless in a hospital’s outpatient department).

Medicare Advantage (Part C): provides the same coverage offered by Parts A and B, including Medicare physical therapy coverage. Many Part C plans require you to visit in-network therapy providers. If you have a Part C plan, check with your insurer to verify you know which physical therapists your plan will cover.