Medicare Coverage of Physical Therapy


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.

Was this medicareinformation helpful?

14 Comments So Far. Add Your Wisdom.

about 1 year ago

can I receive therapy massages, will plan b pay for it.


about 1 year ago

Would medicare plan b pay for my massages, I have fibromyalgia.


Anonymous said about 1 year ago

Will Medicare reimburse a Physical Therapy claim for a person that sits in a wheelchair and waves their arms and legs and repeats nonsense sentence fragments the entire day with her eyes closed? 2 people are needed to stand and pivot her. She has a long history of psychotic behavior and her only response is to become more agitated to any stimuli.


about 1 year ago

i had a stroke 2 years ago and was left unable to walk or use my left arm and hand. with physical therapy i can now stand while wearing a brace and get into a power wheelchair. i can take a few steps but need more therapy to complete. my home health pt person has tol me i will be discharged soon. i am very upset because the therapy is very important for continuing progress. what can i do? diane


over 1 year ago

Please provide clarification on a physical therapy assistant being paid under their the group provider number, when treting without a PTL on site?


over 1 year ago

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?


Anonymous said about 2 years ago

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...


about 3 years ago

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


about 3 years ago

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??


about 3 years ago

Easy to understand.


over 3 years ago

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


Anonymous said over 3 years ago

No. Help. At. ALL


over 3 years ago

Can anyone tell me the number of visits medicare will cover for physical therapy??


about 4 years ago

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.


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