Does Medicare Physical Therapy?

Medicare Part B and Medicare Advantage plans (Part C) pay for outpatient physical therapy services, speech language pathology and occupational therapy. This includes therapy you receive at a therapist's office, hospital outpatient department or other Medicare-approved facility.

Medicare Part B typically covers 80% of your physical therapy costs after you meet your annual Part B deductible.

If you have a Medicare Advantage plan, your copays and deductible may vary. Medicare Advantage plans may also cover benefits not covered by Original Medicare (Part A and Part B).

What Is Physical Therapy?

Physical therapy is a type of rehabilitation that helps individuals recover from injuries, illnesses or surgeries. It can also help manage chronic conditions like arthritis or back pain that impact your ability to function normally.

Physical therapists use exercises, stretches and other techniques to:

• Improve mobility
• Reduce pain
• Increase strength

How Much Does Physical Therapy Cost With Medicare?

With Medicare Part B coverage, you will typically be responsible for paying 20 percent of the Medicare-approved amount for outpatient physical therapy services, once you meet your annual deductible.

In 2023, the Part B deductible is $226 per year. This means that before Medicare pays for outpatient physical therapy expenses, you must first pay this amount out-of-pocket for doctor and outpatient services during the year.

After meeting your deductible, you are required to pay a coinsurance of 20 percent of the Medicare-approved amount for outpatient occupational therapy and physical therapy received at approved locations such as hospitals, clinics and doctor's offices. 

For example, if Medicare approves a payment of $100 per session towards your physical therapy treatment plan consisting of ten sessions in total, then you would need to contribute $20 per session or $200 overall (if you already met your Part B deductible).

What Types of Physical Therapy Are Covered by Medicare?

Medicare Part B covers outpatient physical therapy services, including:

• Diagnostic tests
• Physical therapy evaluations
• Treatment sessions
• Home exercise programs and some home health services

When Does Medicare Pay for Physical Therapy?

Medicare covers physical therapy costs when they are deemed medically necessary by a healthcare provider.

This means that the therapy must be related to a specific injury, illness or condition that is expected to improve with treatment. In these cases, the health conditions require physical therapy.

Medicare may also cover physical therapy services as part of a preventive care plan to help beneficiaries maintain their overall health and wellbeing.

Where to Receive Physical Therapy Services

Knowing where to receive physical therapy services is essential for seniors looking to take advantage of Medicare coverage. Outpatient physical therapy can be obtained at various approved locations, ensuring you have access to the care you need.

• Hospitals: 
  Many hospitals offer outpatient physical therapy departments or clinics within their facilities. These centers offer extensive care, with experienced therapists working in tandem with your medical team. To find a hospital near you that offers these services, you can use the Medicare Care Compare tool.
  
  
• Clinics: 
  Standalone outpatient rehabilitation centers specialize in providing physical therapy, occupational therapy, and speech-language pathology services. They often have flexible hours and may even offer weekend appointments for added convenience. You can search for a clinic using the Medicare Physician Compare tool.
  
  
• Doctor's Offices: Some doctor's offices also provide on-site physical therapy as part of their practice offerings. This option allows patients to receive coordinated care from both their primary physician and therapist under one roof.

Conclusion

Medicare covers physical therapy, but there may be limitations on the number of visits or types of services covered. Beneficiaries should also be mindful of any additional expenses they may incur, such as deductibles, coinsurance and copayments.

If you require physical therapy, it's important to know that Original Medicare covers both inpatient and outpatient physical therapy services. Medicare Advantage plans – which are sold by private insurance companies and are required to cover all Part A and Part B benefits – may cover other benefits Original Medicare doesn't cover.

Learn more and find out if any Medicare Advantage plans available where you live cover benefits Original Medicare doesn't cover.