Does Medicare Cover Physical Therapy?
Short answer
Yes. Medicare Part B covers medically necessary outpatient physical therapy when an eligible health care provider certifies that you need the services. Therapy can be covered to improve function, maintain current function, or slow a decline when the services are reasonable and necessary.
What physical therapy can address
Physical therapy can evaluate and treat movement problems caused by injury, illness or surgery. Medicare coverage is not limited to situations where full recovery is expected; medically necessary skilled therapy can also be used to maintain function or slow deterioration.
Certification and medical necessity
A doctor or other eligible health care provider must certify that you need outpatient physical therapy. The treatment plan and clinical record must support why skilled therapy is reasonable and necessary. Medicare does not pay simply because a patient prefers ongoing supervised exercise.
There is no annual dollar cap on medically necessary outpatient therapy
Medicare no longer imposes a fixed annual dollar limit on medically necessary outpatient physical therapy. That does not mean every amount of therapy is automatically covered: Medicare can require additional documentation and review as therapy expenses increase, and each service must remain medically necessary.
What you may pay
Under Original Medicare, the Part B deductible and coinsurance generally apply to covered outpatient physical therapy. Costs can also depend on the setting and assignment. If a provider believes a service will not be covered as medically necessary, Original Medicare notice rules may apply before you become responsible for the charge.
Medicare Advantage
Medicare Advantage plans must cover Medicare-covered therapy but may use networks, authorization requirements and different cost sharing. Verify the plan’s current rules before starting or extending a course of therapy.