Does Medicare Cover Physical Therapy?

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Treatment. Cropped image of male patient lying down with female physiotherapist performing some stretch exercises on mans leg


Physical therapy is an important part of recovery for many conditions and surgeries. It can make a huge impact on the speed and success of these recoveries. But if you’re covered with Medicare, you’re probably wondering, “Does Medicare cover physical therapy?” Or are you going to be left footing the bill?

Read on to find out the answer and more in this guide!

Physical Therapy

Physical therapy (PT) is a type of rehabilitative health care. It uses specialized equipment and exercises to help improve or regain physical mobility.

It’s suitable for a wide range of patients. A few types of patients include:

  • Babies/infants born with musculoskeletal defects
  • Adults with sciatica
  • Patients who have suffered an injury or been in an accident
  • Poststroke patients

Medicare Cover

In general, Medicare plans help pay for any physical therapy services your doctor orders to treat you. But, your Medicare PT coverage depends on where you get these services.

Medicare Part B will, usually, cover physical therapy. After you meet your deductible, Part B will usually cover 80% of the cost if you access the services:

  • At the hospital
  • At an outpatient center
  • In your doctor’s office

But, if you need PT services in your home, your Medicare Part A or B might cover 100% of the charges. To access this, you will need to meet the following criteria:

  • Must be under a doctor’s care
  • Your physical therapy must be part of a plan reviewed by your doctor on a regular basis
  • Your doctor must certify you as homebound
  • A qualified physical therapist must conduct the PT treatments
  • The agency proving the service must have Medicare certification
  • Your doctor believes your condition will improve with PT. Or PT will stop your condition from becoming worse.

If these home services are part-time or intermittent, Medicare is unlikely to cover it. If you do qualify, you won’t pay anything for the therapy. You only pay 20% of the charges for any medical equipment you might need during the treatments.

Caps

As of 2018, there isn’t a limit on how much physical therapy you can receive each year. But, once it reaches a certain amount, your doctor has to provide extra information on your record.

This amount is $2,010 for physical, speech, and occupational therapies. When you hit this amount, your doctor has to explain why the services are a medical necessity. And also why they’re reasonable.

Medicare may review your claim once you reach $3,000 of therapy treatment. If they decide that your doctor hasn’t provided enough information or justification, they may stop covering any further services.

Does Medicare Cover Physical Therapy? – Now You Know

So there’s the answer to “does medicare cover physical therapy?” Yes, it does. If you’re receiving treatment in a designated medical facility, it covers 80% of the costs.

If you need to receive physical therapy at home, you could see 100% of the PT costs covered. But, only if you meet the set requirements. And while no caps apply, there are price points where reviews take place so make sure your doctor is prepared.

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