Does Medicare Cover Occupational Therapy?

Occupational therapy (OT) helps people recover after an illness, injury or surgery by improving daily tasks, like dressing, bathing or cooking. It’s especially helpful for older adults managing chronic conditions or regaining independence.

Many confuse OT with physical therapy (PT), but they’re different: PT builds movement and strength, while OT focuses on daily function.

Medicare covers OT when it’s medically necessary and ordered by a doctor. Coverage depends on your plan and where you get care.

Original Medicare (Part A and B) and Medicare Advantage (Part C, which replaces Part A and B) both cover OT.

This guide explains just how Medicare covers OT and what to expect.

What Is Occupational Therapy and Who Can Benefit?

Occupational therapy (OT) helps people stay independent by building or rebuilding skills needed for daily life, like dressing, cooking or managing medication.

It’s different from physical therapy (PT). PT helps build movement, strength and balance, while OT focuses on everyday tasks and thinking skills. Many people use both during recovery.

Older adults often benefit from OT when they’re:

• Recovering from a fall, surgery or joint replacement
• Living with arthritis, stroke, Parkinson’s or memory issues
• Managing changes in strength, coordination or mood
• Adjusting to a new disability or using a prosthetic

Occupational therapists use hands-on care, tools and training to help people live safely and confidently at home.

What Services Do Occupational Therapists Provide?

Occupational therapists help people safely perform daily activities by building skills, adapting environments or using assistive tools.

Examples of activities that an OT may help teach members how to succeed with include:

• Dressing, bathing, eating and grooming
• Teaching fall prevention and home safety
• Supporting memory, focus and other thinking skills
• Training caregivers on safe routines
• Suggesting tools or home changes, like grab bars or easy-to-use utensils

These services are tailored to the patient’s needs and are designed to promote independence and reduce the risk of injury.

Medicare Coverage for Occupational Therapy

Medicare covers occupational therapy (OT) when it’s medically necessary and prescribed by a doctor. The part of Medicare that applies depends on where you get care.

Medicare Part A

Part A covers OT when you receive it as part of inpatient care, such as:

• A hospital stay after surgery or serious illness
• A skilled nursing facility (SNF) for short-term rehab
• Home health services, if OT is part of a broader care plan
• Hospice care to support comfort and function

Occupational therapy must be medically necessary and included in a care plan certified by your doctor.

Part A Costs in 2025:

• Premium: Free for most people with 40+ work credits
• Deductible: $1,632 per benefit period
• Coinsurance: Varies based on length of stay
  • Days 1-60: $0
  • Days 61-90: $408 per day
  • Days 90 +: lifetime reserve days apply with higher costs

To learn more about how long rehab stays are covered, visit: How Long Does Medicare Cover Rehab? [Insert Link]

Medicare Part B

Part B covers outpatient OT, such as visits to:

• A therapist's office or rehab center
• A hospital outpatient department
• Your home (if you qualify for home health care)

Requirements for Coverage

• Medically necessary
• Prescribed by a Medicare-approved doctor
• Provided by or under the supervision of a licensed occupational therapist

Examples of covered OT under Part B:

• Regaining hand use after a stroke
• Adapting to daily tasks after a hip replacement
• Managing arthritis to maintain independence
• Relearning skills after limb loss

Part B Costs in 2025:

• Monthly premium: $185
• Deductible: $257
• Coinsurance: 20% of the Medicare-approved amount after deductible is met

Some Medicare Supplement (Medigap) plans can help cover these costs.

Medicare Part C

Medicare Advantage (Part C) plans are an alternative to Original Medicare. When you enroll in a Part C plan, it replaces your Part A and Part B coverage. You cannot have both Original Medicare and Medicare Advantage at the same time.

Part C plans must cover all OT benefits included in Original Medicare, and many also offer extra benefits like:

• Lower out-of-pocket costs for therapy
• Access to in-network therapists
• Added services like fall prevention or wellness tools

Since these plans are offered by private insurers, costs and coverage vary. Always check your plan’s Evidence of Coverage (EOC) for:

• Referral or prior authorization rules
• Your exact copay or coinsurance
• Which OT providers are in-network

How Much Will Medicare Pay for Occupational Therapy?

If you get outpatient occupational therapy through Medicare Part B, Medicare pays 80% of the approved cost for each session, as long as your provider accepts Medicare. You’ll pay the remaining 20% coinsurance after meeting your Part B deductible ($257 in 2025).

No Annual Cap on OT Services

There’s no dollar cap on how many therapy sessions Medicare will cover each year. However, it must remain medically necessary.

KX modifier and Cost Threshold

In 2025, if your OT services exceed $2,410, your provider must add a KX modifier (short for “Keep Exceeding”) to your claim. This tells Medicare that therapy is still medically necessary.

• Medicare still pays 80% of the approved cost
• You still owe 20% coinsurance, no matter how many sessions you need
• Services beyond the threshold may be reviewed by Medicare
• Your therapist must show that continued therapy is medically necessary.

What If My Doctor Recommends Additional Services?

Your doctor or occupational therapist may suggest services that go beyond what Medicare covers. They may support your recovery, but if they aren’t considered medically necessary, Medicare may not pay for them.

When Medicare May Not Cover OT

Medicare does not cover:

• Therapy for general wellness or long-term maintenance
• Services that don’t require a skilled therapist
• Extra sessions after your condition has stabilized or stopped improving

How to Check Coverage for Extra Services

To avoid unexpected costs, you can:

• Ask your provider if the service is covered by Medicare
• Review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB)
• Call 1-800-MEDICARE or check medicare.gov
• Review your Medicare Advantage Evidence of Coverage (EOC) if applicable

Out-of-Pocket Costs and Medicare Advantage

If you have Original Medicare, you’ll usually pay the full cost for any services that aren’t covered. But if you’re enrolled in a Medicare Advantage (Part C) plan, which replaces your Original Medicare, your costs and coverage may be different.

Many Advantage plans offer extra benefits that Original Medicare does not, such as:

• More rehab services
• Wellness or fitness programs
• Flex cards or over-the-counter (OTC) allowances for home equipment

Each Medicare Advantage plan is unique. Always check your plan details to confirm what’s included and how much you’ll pay.

FAQs

What’s the difference between occupational therapy and physical therapy?

While both therapies aid recovery, they serve different purposes. Physical therapy focuses on improved strength, balance and range of motion, especially after injury or surgery. Occupational therapy helps you regain the ability to perform everyday tasks like bathing, dressing and cooking.

Does Medicare need to approve my occupational therapist?

Yes. Medicare will only cover occupational therapy services provided by a licensed occupational therapist or their supervised staff. The provider must accept Medicare assignment (for Original Medicare) or be in-network for your Medicare Advantage plan.

What can Medicare Advantage cover that Original Medicare may not?

Medicare Advantage plans must cover all the same occupational therapy services as Original Medicare, but many plans may offer extra support. This can include lower copays, wellness programs, in-home therapy visits or transportation to appointments.

Note: Benefits vary by plan and location. Always check your plan’s details to know exactly what’s covered.

Sources

• Ncoa.org: How Much Does It Cost for Medicare Parts A and B?
• CMS.gov: 2025 Medicare Parts A & B Premiums and Deductibles
• Medciare.gov: Costs
• CMS.gov: Medicare Claims Processing
• Medicare.gov: Occupational therapy services
• Medicare.gov: Medicare Coverage of Therapy Services
• Medicare.gov: Physical therapy services
• apta.org: Medicare Payment Thresholds for Outpatient Therapy Services
• https://www.cms.gov/medicare/coding-billing/therapy-services
• ngsmedicare.com: Physical Therapy/Occupational Therapy/Speech Therapy
• healthline.com: Medicare and Occupational Therapy Coverage

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