Does Medicare Cover Physical Therapy?

Does Medicare Cover Physical Therapy?

If a medical professional has recommended that you get physical therapy as part of your treatment, you likely have some questions, and one of the first might be, "does Medicare cover physical therapy?"

Doctors recommend physical therapy for a wide variety of conditions, including work-related injuries, arthritis, stroke and Parkinson's Disease. If you're looking for information about assistance with physical therapy costs, here's what you need to know about Medicare coverage.

Does Medicare Cover Physical Therapy Costs?

The short answer to the question is yes, Medicare can help with these expenses. Physical therapy costs are included under Medicare Part B, which helps to pay for "medically necessary" outpatient physical therapy. Part B services refer to doctor services, outpatient care, medical supplies and preventive services.

Under Medicare Part B, you would be responsible for first paying the 2020 deductible of $198 and at least 20% of the Medicare-approved expenses for each session, which pays the professional providing the service.

It's important to ask your doctor or physical therapist how much they will charge for your treatments, as they might charge more than the Medicare-approved amount. In that case, you would be responsible for paying the difference.

Medicare and Physical Therapy: What Services Are Covered

Outpatient therapy services covered by Medicare include:

  • Physical therapy (PT).
  • Speech-language pathology (SLP).
  • Occupational therapy (OT).

Medicare outpatient therapy services include services provided at locations such as:

  • Therapists' or doctors' offices.
  • Comprehensive outpatient rehabilitation facilities.
  • Skilled nursing facilities.
  • The patient's home, if they utilize health home agencies when they do not qualify for Medicare's home health benefit.

Medicare Part B does not cover physical therapy expenses in all situations. For example, if you get therapy during a Medicare-covered skilled nursing facility stay or under the home health benefit, you won't get additional coverage under Medicare.

To find out if Medicare covers your particular therapy, visit the Medicare Physical Therapy site and input the name of your treatment.

Medically Required Therapy Cost Thresholds and Limits

As of 2018, Medicare no longer has an annual limit on medically required outpatient physical therapy costs, and there is no longer a limit on how many sessions are covered weekly or monthly within a year. However, you'll still need to pay 20% of the Medicare-approved payment for each session, so more sessions will mean more out-of-pocket expenses for you.

Once your total therapy costs reach a certain threshold, you'll need to provide confirmation that the therapy is medically required.

For 2020 the therapy cost thresholds are:

  • $2,080 for PT and SLP.
  • $2,080 for OT.

If your total therapy costs exceed $3,000, Medicare might request a targeted medical review to examine the medical reasons for your therapy. Keep in mind that your healthcare professional could recommend therapy not covered by Medicare. If so, you'll pay the costs directly unless you have other insurance that covers it.

Working With a Physical Therapist Who Accepts Medicare

To find a physical therapist in your area who accepts Medicare, you could ask your doctor or do a quick online search using your zip code or city and the words "physical therapist Medicare."

Be sure to research the Medicare coverage for your physical therapy recommendations before booking your first appointment so you can make a wise financial decision when you choose your physical therapist.

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