Physical therapy helps people regain strength, improve mobility, reduce pain, and recover from injuries, surgeries, or chronic conditions. For many older adults, it becomes an essential part of staying independent and managing daily activities. Medicare beneficiaries often ask whether this important service receives coverage.
Medicare Part B provides coverage for medically necessary physical therapy when specific requirements are met. Coverage focuses on skilled, time-limited treatment rather than ongoing maintenance or general fitness. This distinction matters greatly for patients who need therapy to restore function after an event.
Many people assume physical therapy continues indefinitely under Medicare. In reality, coverage has limits tied to medical necessity and progress toward specific goals. Understanding these rules helps avoid unexpected costs and ensures appropriate use of benefits.
Medicare Part B Coverage for Physical Therapy
Medicare Part B covers outpatient physical therapy when a physician or qualified non-physician practitioner orders it. The therapy must be reasonable and necessary to improve, maintain, or prevent further decline in function. Skilled services require the expertise of a licensed physical therapist.
Coverage includes evaluation, therapeutic exercises, manual therapy, gait training, neuromuscular reeducation, and modalities such as ultrasound or electrical stimulation when medically justified. Home-based outpatient therapy also qualifies if the patient cannot travel to a clinic.
Medicare pays 80% of the approved amount after the annual Part B deductible is met. The patient pays the remaining 20% coinsurance. No separate copayment applies for therapy visits in most settings.
Medical Necessity and Plan of Care Requirements
Physical therapy must follow a written plan of care established by the therapist and approved by the referring physician. The plan outlines specific goals, frequency, duration, and expected outcomes. Progress toward these goals must be documented regularly.
Medicare requires certification of the plan of care every 90 days or sooner if changes occur. A face-to-face encounter with the physician or qualified practitioner must occur within 30 days before or after starting therapy. This ensures ongoing medical oversight.
If therapy does not show measurable improvement or the goals are met, coverage ends. Maintenance therapy to prevent decline without skilled need does not qualify. Documentation of functional progress supports continued coverage.
Therapy Caps and Thresholds
Medicare no longer enforces strict annual dollar caps on physical therapy. Instead, a threshold amount triggers additional review. In 2025 and beyond, providers must use the KX modifier on claims once spending exceeds the annual threshold to confirm continued medical necessity.
The threshold amount is adjusted annually for inflation. When exceeded, therapists must document that services remain reasonable and necessary. Medicare may request targeted medical review for claims above a higher review threshold.
These mechanisms prevent overuse while allowing coverage for patients who genuinely need extended therapy. Most patients never reach these thresholds during a benefit period.
Comparison of Physical Therapy Coverage Options
Here’s a comparison of physical therapy coverage under different Medicare paths:
| Coverage Type | Original Medicare (Part B) | Medicare Advantage (Typical) | Common Patient Cost Factors |
|---|---|---|---|
| Medically necessary outpatient PT | Covered (80% after deductible) | Covered + often lower copays | 20% coinsurance after deductible |
| Maintenance or preventive PT | Not covered | Rarely covered | 100% out-of-pocket |
| Home-based outpatient PT | Covered if unable to travel | Covered (may have copay) | Same as clinic visits |
This table shows the core coverage rules and cost responsibilities.
Costs You Pay for Physical Therapy
After meeting the annual Part B deductible (set at $257 in recent updates), you pay 20% coinsurance on each therapy visit. Medicare-approved amounts vary by location and service code. Providers accepting assignment cannot charge more than the approved rate.
Multiple therapy visits per week can add up quickly. For example, three visits weekly at $150 approved amount each results in $90 coinsurance per week after the deductible. Medigap policies cover this coinsurance for Original Medicare users.
Medicare Advantage plans often replace coinsurance with fixed copays per visit, typically $20–$50. Out-of-pocket maximums cap total yearly spending, including therapy costs.
Therapy Settings and Coverage Rules
Outpatient therapy in clinics, private practices, or hospital outpatient departments receives standard Part B coverage. Home health physical therapy qualifies under home health rules when the patient is homebound and skilled care is needed. Skilled nursing facility therapy follows Part A rules during covered stays.
Telehealth physical therapy visits became permanently available after the public health emergency. Medicare covers these when the therapist provides the service remotely using interactive audio and video. Patients pay the same coinsurance as in-person visits.
Each setting has specific documentation and supervision requirements. Coordination between providers prevents gaps in care.
When Coverage Ends or Changes
Coverage ends when therapy goals are met, no further improvement is expected, or the patient no longer needs skilled care. The therapist documents the reason for discharge. Patients can continue exercises independently or pay privately for maintenance sessions.
If a new condition or setback occurs, therapy can restart with a new physician order and plan of care. No annual reset or lifetime limit exists for medically necessary therapy. Each benefit period stands on its own.
Medicare Advantage plans may have visit limits or require prior authorization for extended therapy. Check plan documents carefully.
Tips for Maximizing Physical Therapy Benefits:
- Obtain a physician referral early to start coverage promptly.
- Attend all scheduled sessions to show commitment to progress.
- Keep a simple log of improvements in function or pain levels.
- Ask your therapist about home exercise programs between visits.
- Report any new symptoms promptly to adjust the plan of care.
These steps support better outcomes and stronger documentation.
Alternatives When Medicare Coverage Ends
When skilled therapy ends, many patients continue exercises at home or join community fitness programs. Senior centers, YMCAs, and local health departments often offer low-cost or free classes tailored to older adults. These maintain strength and balance without skilled supervision.
Medicaid covers additional therapy for eligible low-income individuals. Dual-eligible beneficiaries access both Medicare and Medicaid benefits. Long-term care insurance sometimes covers extended rehabilitation services.
Veterans may receive therapy through VA programs. Nonprofit organizations occasionally provide sliding-scale therapy for seniors.
Conclusion
Medicare Part B covers medically necessary outpatient physical therapy when ordered by a physician and provided by qualified therapists. Coverage includes evaluation, treatment, and progress toward functional goals with 80% payment after the deductible. No strict annual cap exists, but documentation of medical necessity remains essential for continued benefits. Medicare Advantage plans often offer lower copays and additional therapy support. Working closely with your therapist, physician, and plan ensures appropriate use of coverage while supporting recovery and long-term mobility.
FAQ
Does Medicare Part B cover physical therapy?
Yes, Medicare Part B covers outpatient physical therapy when it is medically necessary and ordered by a physician. Coverage applies to skilled services aimed at improving, maintaining, or preventing decline in function. You pay 20% coinsurance after the annual deductible.
What is the Medicare Part B deductible for physical therapy?
The Part B deductible applies to physical therapy visits just as it does to other outpatient services. Once met, Medicare pays 80% of approved amounts. The deductible amount is adjusted annually for inflation.
Are there limits on how many physical therapy visits Medicare covers?
Medicare no longer enforces strict annual visit limits. A threshold amount triggers additional documentation requirements, but coverage continues when medical necessity is shown. Most patients never reach these thresholds.
Does Medicare cover physical therapy at home?
Yes, home health physical therapy is covered when the patient is homebound and requires skilled care. Homebound status means leaving home requires considerable effort. Coverage follows home health rules with 100% payment for approved visits.
Does Medicare Advantage cover physical therapy differently?
Medicare Advantage plans cover physical therapy at least as well as Original Medicare. Many replace 20% coinsurance with fixed copays per visit. Some plans have visit limits or require prior authorization.
Is maintenance physical therapy covered by Medicare?
No, Medicare covers therapy only when skilled care is required to achieve or maintain specific functional goals. Purely maintenance or preventive therapy without skilled need does not qualify. Once goals are met, coverage ends.
Can I get physical therapy after a hospital stay?
Yes, Medicare covers physical therapy after a hospital stay if skilled care is needed. Coverage falls under Part B for outpatient therapy or Part A during a covered skilled nursing facility stay. A physician order is required.
What costs will I pay for physical therapy under Medicare?
After the annual Part B deductible, you pay 20% coinsurance on each approved therapy visit. Providers accepting assignment cannot charge extra. Medigap policies cover this coinsurance for Original Medicare users.
Does Medicare cover telehealth physical therapy?
Yes, Medicare permanently covers telehealth physical therapy visits delivered via interactive audio and video. Patients pay the same 20% coinsurance as in-person visits. The therapist must be licensed and enrolled in Medicare.
How do I find a Medicare-participating physical therapist?
Use Medicare.gov to search for participating providers in your area. Confirm the therapist accepts Medicare assignment. Ask about their experience with Medicare documentation and billing requirements.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.