What It Is
Physical therapy, provided on an outpatient basis
What's Covered
Medicare Part B covers a limited amount of physical therapy, provided on an outpatient basis in a doctor's or therapist's office, rehabilitation facility, clinic, hospital outpatient department, or patient's home. The therapy must be prescribed and regularly reviewed by a doctor and be provided by a Medicare-certified therapist.
Medicare Part A or Part B also covers physical therapy as part of comprehensive in-home care provided by a Medicare-approved home healthcare agency.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for physical therapy, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for covered physical therapy provided independently of home healthcare. There's a yearly cap of $1,840 on total Medicare payments for physical therapy (this figure includes any combined speech therapy) provided in any setting other than a hospital outpatient department.
In exceptional circumstances, Medicare Part B may pay more than the yearly cap. But such extra therapy must be preapproved by Medicare based on a special written request submitted by the patient's physician.
If physical therapy is provided in a hospital outpatient department, there's no yearly cap on the total amount Medicare Part B may pay. However, patients may be charged a per-visit co-payment in addition to the 20 percent of the Medicare-approved amount that Medicare doesn't pay.
Medicare Part A or Part B pays 100 percent of the cost for Medicare-covered in-home care provided by a home healthcare agency (including physical therapy). There's no yearly limit on the amount Medicare will pay for covered in-home care.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
Please provide clarification on a physical therapy assistant being paid under their the group provider number, when treting without a PTL on site?
I am completing a course of physical rehab working out after a stint implantation. Can I get additional budget with medicare A and B or medicare suppiiment plan F?
I had 2 hips replacements within 8 months of each other. I gave sufficient time to heal and recover but have never gotten back to walking properly and no physical therapy was prescribed...can I now start a program to try and regain a better pattern of posture and walking? Will medicare cover this ? I have A B and F...
Hello Pauline Maxwell, Thank you very much for your question. If you'd like, you can post it in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager
My sister is in an assisted living place in Houston. It provides a PT for the residents. She has not had what would be called good threapy. First the woman is not a certified PT but under that. SHe has been out on vacation for 2 weeks of this month and has told my sister she can't work with her on mnay occasions of this last month. SHe has also left early without working with my sister who is really anxious to get the PT. Now a woman has come in and looked at my sister's record of last month with the PT gone so much and has told my sister she hasn't improved enough last month to stay on Medicare PT. How could she with the actions of the PT there? I know enough about PTs as I taught pre PT persons at the university here and this PT is not who I would want or who I want for my sister. What can we, as her family do??
Easy to understand.
Hi hurting alot, that's a great question that has been answer by Joseph Matthews on this Ask & Answer page: (http://www.caring.com/questions/what-is-ment-by-medically-neccessary-or-under-what). I hope that answers your question! @anonymous, I'm sorry to hear our article wasn't helpful to you. Hopefully our site will be more helpful to you in the future. -- Emily
No. Help. At. ALL
Can anyone tell me the number of visits medicare will cover for physical therapy??
regarding physical therapy - member of medicare will need physical therapy for shoulder as prescribed and medically necessary by operating surgeon. Prior to had a parotidectomy and had nerve stimulation on face- physical therapy. THIS IS A TOTALLY DIFFERENT BODY PART, i. e. - face and then shoulder. PLEASE CLARIFY PAYMENT. THANK YOU.