Does Medicare Cover Physical Therapy?

Original Medicare includes coverage for “medically necessary” physical therapy.

Medicare pays a lot of the costs of physical therapy if it is medically necessary. It is often necessary for those 65 years and older. Nearly 3 million Medicare beneficiaries received PT during surgery recovery or injury in 2019. This helps to decrease pain and improve mobility.

What is the coverage of Original Medicare for physical therapy?

Medicare Part B covers 80% of charges for outpatient physical therapy after you pay the deductible, which is $203 for 2021. A 20% copayment will be charged to your account.

Notice: Medicare defines “medically necessary” as: “Healthcare services or supplies required to diagnose or treat an illness or injury, condition, disease or its symptoms, and that comply with accepted standards of medicine.”

Medicare may ask for documentation from your doctor if physical therapy costs exceed $2,010.

A number of conditions are required to be eligible for physical therapy at home covered by Original Medicare. You must have a doctor certify that your condition is homebound. Also, you must be receiving care according to a care plan. To make physical therapy safe and effective, a therapist must be present.

Is Medicare able to pay for inpatient physical therapy?

Medicare Part A covers some of the costs of inpatient physical therapy provided at a facility such as an acute care rehabilitation center or rehabilitation hospital. For the first 60 days of inpatient rehabilitation, you may be required to pay a deductible up to $1.364. Your costs will skyrocket from days 61-90 to a $341 daily coinsurance payment; by day 91 you’ll pay $682 per person.

Are Medicare Advantage and Medigap able to provide more coverage?

If you have another type of Medicare, you may be eligible to lower or eliminate Original Medicare’s 20% copay on outpatient physical therapy. To find out if your Medicare Advantage (Medicare Supplemental Insurance) plan will lower your out-of pocket cost for physical therapy, check with them.

Ask your physical therapist questions

  • What number of physical therapy sessions is my treatment going to require?
  • How much does each appointment cost for physical therapy?
  • If total charges exceed $2,000.10, have you submitted documentation to Medicare in order to continue my treatment?