Does Medicare Cover Physical Therapy?

Physical therapy is a crucial part of maintaining healthy mobility and function. It can also help prevent future injuries, reduce pain and manage chronic conditions. Understanding how Medicare covers these services can help you make informed decisions about your care. We’ll break down what Original Medicare covers, how to access physical therapy, and what you need to know to maximize your benefits.

Medicare Overview

Medicare is a federal health insurance program primarily for people aged 65 and older, as well as some younger people with disabilities. It's divided into several parts. Here’s a quick overview:

Medicare Part A (Original Medicare): Covers inpatient hospital stays, skilled nursing facility care, and hospice care.

Medicare Part B (Original Medicare): Covers outpatient care, including doctor visits, preventive services, and some home health services.

Medicare Part C (Medicare Advantage): plans offered by private companies that bundle the same coverage as parts A and B, and often include additional benefits like hearing, dental and vision coverage.

Medicare Part D: Covers prescription drugs.

Medicare Part B Coverage

Medicare Part B covers outpatient therapy, including physical therapy, occupational therapy, and speech and language pathology services. These services could be provided in a variety of settings, including:

• Doctor or physical therapist's office
• Outpatient rehabilitation facility
• Hospital outpatient facility
• Skilled nursing facility if you're being treated as an outpatient
• At your home in some cases when you’re not eligible for Medicare’s home health benefit

Coverage Limits

In the past, Medicare had a cap on how much it would pay for outpatient physical therapy in a calendar year. However, this cap was removed in 2018.

Instead, Medicare uses a "therapy threshold" to monitor the amount of therapy you receive. If your therapy costs exceed a certain amount (around $2,410 in 2025), your healthcare provider must document that the therapy is medically necessary. Medicare will continue to cover the therapy if it is deemed necessary.

Medicare.gov defines medically necessary services or supplies as “those that meet accepted standards of medical practice to diagnose or treat your medical condition.”

Coinsurance and Deductibles

Medicare Part B typically covers 80% of the approved amount for physical therapy services after you meet your annual deductible (which is $257 in 2025). You are responsible for the remaining 20% coinsurance, a copay and any additional costs not covered by Medicare.

Medicare Part A Coverage

If you are admitted to a hospital or skilled nursing facility, Medicare Part A may cover physical therapy as part of your inpatient care. This can include physical therapy sessions at the facility as well as equipment and supplies used during therapy.

Medicare Advantage (Part C) Coverage

Medicare Advantage plans, which are offered by private insurance companies, must cover at least the same benefits as Original Medicare (Parts A and B). However, many Medicare Advantage plans offer additional benefits, including more comprehensive physical therapy coverage. Some plans may cover more sessions or have lower out-of-pocket costs. It’s important to review the benefits of your chosen plan carefully.

8 a.m.-8 p.m., 7 days a week.

How to Access Physical Therapy Through Medicare

• Find a Physical Therapist: You can find a physical therapist who accepts Medicare by asking your primary care physician for a referral or by searching online. Make sure the therapist is enrolled in Medicare and accepts assignment, which means they agree to accept Medicare’s approved amount as full payment. If you have a Medicare Advantage plan, ensure the provider is in your plan’s network.
• Understand Your Plan: Review your Medicare plan to understand your specific coverage, including any deductibles, coinsurance, and out-of-pocket costs. If you have a Medicare Advantage plan, check the plan’s summary of benefits for any additional coverage or restrictions.
• Keep Records: Keep detailed records of your physical therapy visits, including dates, costs, and any documentation provided by your therapist. This can be helpful if you need to file a claim or appeal a decision.

Whether you have Original Medicare or a Medicare Advantage plan, physical therapy can be a valuable part of your healthcare. By following the steps outlined above and staying informed about your plan, you can ensure that you receive the care you need to maintain your health and mobility.

8 a.m.-8 p.m., 7 days a week.

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Mga Mapagkukunan

• Medicare.gov: Physical Therapy Services
• CMS.gov: Coding/Billing – Therapy Services
• Medicare.gov: Original Medicare/Part B

Mga Disclaimer