Does Medicare Cover Physical Therapy

When does Medicare cover physical therapy?

Medicare Part B will help to pay for outpatient PT that’s medically necessary. A service is considered medically necessary when it’s needed to reasonably diagnose or treat a condition or illness. PT can be considered necessary to:

• improve your current condition
• maintain your current condition
• slow further deterioration of your condition

For PT to be covered, it must involve skilled services from a qualified professional like a physical therapist or doctor. For example, something like providing general exercises for overall fitness wouldn’t be covered as PT under Medicare.

Your physical therapist should give you written notice before providing you with any services that wouldn’t be covered under Medicare so you can decide whether to have them.

Which parts of Medicare cover physical therapy?

Let’s further break down the different parts of Medicare and how the coverage provided relates to PT.

Part A

Medicare Part A is inpatient hospital insurance. It covers things like:

• inpatient stays at:
  • hospitals
  • mental health facilities
  • rehabilitation centers
  • skilled nursing facilities
• hospice care
• home healthcare

Part A can cover inpatient rehabilitation and PT services when they’re considered medically necessary to improve your condition after hospitalization.

Part B

Medicare Part B is outpatient medical insurance. It covers medically necessary outpatient services. Part B may also cover some preventive services.

Medicare Part B covers medically necessary PT. This includes both the diagnosis and treatment of conditions or illnesses that affect your ability to function.

You can receive this type of care at the following types of facilities:

• medical offices
• privately practicing physical therapists
• hospital outpatient departments
• outpatient rehabilitation centers
• skilled nursing facilities (when Medicare Part A doesn’t apply)
• at home (using a Medicare-approved service)

Medicare Advantage (Part C)

Medicare Part C plans are also known as Medicare Advantage. Unlike parts A and B, they’re offered by private companies that Medicare has approved.

Medicare Advantage plans must cover the same as Original Medicare’s parts A and B, and this includes medically necessary PT.

These plans can also cover additional services, like dental, vision, and prescription drugs. What’s included in a Medicare Advantage plan varies by plan type, insurer, and location.

If you have a Medicare Advantage plan, you should check for information regarding any plan-specific rules for therapy services.

Part D

Medicare Part D provides prescription drug coverage. Like Medicare Advantage, private companies approved by Medicare administer Part D plans. The medication covered can vary by plan.

Part D plans don’t cover PT. However, if prescription medications are a part of your treatment or recovery plan, Part D may cover them.

Medigap

Medigap is also called Medicare supplement insurance. Private companies administer these plans, and they can cover some of the out-of-pocket costs associated with Original Medicare, including:

• deductibles
• copayments
• coinsurance
• medical care when you’re traveling outside the United States

Although Medigap may not cover PT, some policies may help to cover the associated copayments or deductibles.

How much does physical therapy cost?

The cost of PT can vary greatly, and many factors can affect the cost, including:

• your insurance plan
• the specific type of PT services that you need
• the duration or number of sessions involved in your PT treatment
• how much your physical therapist charges
• your location
• the type of facility you’re using

Coinsurance can also be a big factor in Medicare PT costs. Medicare coinsurance is a percentage amount you must pay toward each visit. Medicare pays 80% of an approved fee for PT, and you must pay 20%. You may also have to pay anything your physical therapist charges over the Medicare-approved fee. If you need to have many PT sessions, this cost can quickly add up.

A 2019 study found that the average outpatient PT expenditure per participant was $1,488 annually. This varied by diagnosis, with neurological conditions and joint replacement expenditures being higher while genitourinary conditions and vertigo were lower.

Coverage and payments

Once you’ve met your Part B deductible, which is $257 for 2025, Medicare will pay 80% of your PT costs. You’ll be responsible for paying the remaining 20%. There’s no longer a cap on the PT costs that Medicare will cover.

After your total PT costs exceed a specific threshold, your physical therapist must confirm that the services provided remain medically necessary for your condition. For 2025, this threshold is $2,410.

Your physical therapist will use documentation to show that your treatment is medically necessary. This includes evaluations of your condition and progress as well as a treatment plan with the following information:

• diagnosis
• the specific type of PT you’ll be receiving
• the long-term PT treatment goals
• number of PT sessions you’ll receive in a single day or single week
• total number of PT sessions needed

Until 2028, when total PT costs exceed $3,000, a targeted medical review may be performed. However, not all claims are subject to this review process.

Which Medicare plans may be best if you need physical therapy?

Original Medicare parts A and B cover medically necessary PT. If you know you’ll need it in the coming year, having just these parts may meet your needs.

If you’re concerned about additional costs that aren’t covered by parts A and B, you may consider adding a Medigap plan which can help pay for some of Original Medicare’s out-of-pocket costs.

Medicare Advantage (Part C) plans include the coverage from parts A and B. However, they may also cover additional services. If you’ll need coverage of dental, vision, or fitness programs in addition to PT, consider a Medicare Advantage plan.

Part D includes prescription drug coverage. It can be added to Original Medicare and is often already included in Medicare Advantage plans. If you already take prescription medications or know that they may be a part of your treatment plan, Part D may be right for you.

The takeaway

Medicare Part B covers outpatient PT when it’s medically necessary, which means that the PT you receive is required to reasonably diagnose or treat your condition.

There’s no cap on the PT costs that Medicare will cover. However, after a certain threshold, your physical therapist must confirm that the services you’re receiving are still medically required.

Other Medicare plans, such as Medicare Advantage and Medigap, can also cover costs associated with PT. If you’re looking at one of these, remember to compare several options before selecting one since coverage can vary by insurer.