Does Medicare Cover Outpatient Rehabilitation?
Short answer
Part B can cover medically necessary outpatient rehabilitation, including physical therapy, occupational therapy and speech-language pathology, when skilled therapy requirements are met.
Coverage
Therapy must be furnished by qualified professionals under an appropriate plan of care and be reasonable and necessary for the beneficiary’s condition.
Not Automatic
Medicare does not require a beneficiary to be improving for therapy to qualify; skilled maintenance therapy can be covered when needed to maintain function or slow decline. But routine exercise or non-skilled assistance is not automatically covered.
Costs And Ma
Part B cost sharing generally applies. Medicare no longer has a fixed annual therapy cap, though documentation and review thresholds can apply. Medicare Advantage may use networks or authorization.
Practical Example
A beneficiary with Parkinson’s disease may receive covered skilled therapy to maintain safe mobility even if full recovery is not expected.
Questions to verify
- Is the therapy skilled and medically necessary?
- Is the plan of care current?
- Does my MA plan require authorization?