Yes, Medicare covers medically necessary physical therapy. This coverage extends to the inpatient physical therapy provided in settings like rehabilitation facilities as well as the outpatient physical therapy provided in private clinics, and at home under certain conditions.
Medicare coverage for physical therapy helps beneficiaries pay for the rehabilitation care they need to get or stay healthy. However, the program does not necessarily cover the entire cost of treatment. Limits or other criteria may apply to Medicare physical therapy, depending on the setting where a person receives their care.
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What Is Physical Therapy?
Physical therapy is a rehabilitation therapy that helps people improve, recover, or maintain their abilities. The goals of this treatment vary from one person to another but could include reducing pain and stiffness or improving strength and range of motion.
People with Medicare seek physical therapy for many different health conditions. For example, maybe you need help recovering from a major surgery, such as a joint replacement, or a serious injury, such as a dislocation or fracture. Maybe you’re living with a chronic condition, such as arthritis, and need help managing the symptoms.
Because there are so many applications for physical therapy, sessions can look very different from one patient to another. Some examples of treatments physical therapists may provide include:
- Therapeutic exercises: Stretches and exercises designed to improve a person’s flexibility, balance, endurance, or strength.
- Manual therapy techniques: Hands-on treatments, such as massage or traction, that help patients complete their therapeutic exercises.
- Electrotherapy techniques: Treatments that use electrical currents, such as transcutaneous electrical nerve stimulation or biofeedback.
- Heat and cold therapies: The application of ice or heat packs.
How Does Medicare Cover Physical Therapy?
Medicare covers physical therapy services through Part A and/or Part B. The parts of Medicare that cover your treatment and how often Medicare pays for physical therapy depends on where you receive care.
Part A Coverage
Medicare Part A (Hospital Insurance) covers the inpatient physiotherapy beneficiaries receive when admitted to a hospital, inpatient rehabilitation facility, skilled nursing facility, or hospice facility. It also offers coverage for in-home physical therapy through its home health benefit.
Part A’s physiotherapy coverage varies depending on the treatment setting. For example, Medicare covers the full cost for people receiving hospice or home health care. People who receive inpatient treatment in a hospital or skilled nursing facility pay some of the costs, depending on the length of their stay.
Eligibility
The eligibility criteria for Part A-covered physical therapy vary depending on the treatment setting. For example, it covers physiotherapy in a skilled nursing facility if the following conditions are met:
- The beneficiary spent at least three days as a hospital inpatient.
- Their doctor says they need daily skilled care to recover.
- The beneficiary needs physical therapy to meet their health goal.
Part B Coverage
Medicare Part B (Medical Insurance) covers outpatient physical therapy services. Beneficiaries can receive these services in various settings, such as doctors’ offices, physical therapy clinics, rehabilitation facilities, and hospitals. Eligible beneficiaries can also receive Part B-covered physical therapy at home.
Part B covers outpatient physical therapy after a beneficiary reaches their Part B deductible of $226 in 2023. Then, it pays 80% of the Medicare-approved amount for each treatment session, while the beneficiary pays 20%. There is no annual limit on the amount Medicare pays for medically necessary outpatient physical therapy.
Eligibility
Medicare Part B covers beneficiaries’ outpatient physiotherapy treatments if the following conditions are met:
- The beneficiary is under the care of a physician.
- A physical therapy care plan has been established.
- The services are medically necessary.
- The frequency and duration of the sessions are reasonable.
How Often Will Medicare Pay for Physical Therapy?
Original Medicare does not set an annual limit on outpatient physical therapy. The program covers treatment as often as needed, as long as it is reasonable and medically necessary.
After a beneficiary’s Medicare physical therapy costs reach a certain amount, their provider must certify that the treatment is still medically necessary before coverage continues and attach a modifier on the claim billed to Medicare. For 2023, the amount is $2,230 for physiotherapy and speech therapy services combined.
Some limits apply to inpatient treatment. For example, Part A covers up to 90 days of care per benefit period in an inpatient rehabilitation facility. The limit for inpatient skilled nursing facility care is 100 days.
How Does Medicare Advantage Cover Physical Therapy?
Medicare Advantage Plans are required to cover the same services as Original Medicare, including inpatient and outpatient physiotherapy. However, these private health plans may have different costs or rules for accessing care.
While Original Medicare offers nationwide coverage, most Medicare Advantage Plans provide a network of healthcare providers and facilities. Some plans require members to choose a provider that belongs to the network, while others provide partial coverage for out-of-network treatment.
Medicare Advantage Plans may set prior authorization requirements for care. Prior authorization means members need to get approval from their plan before it covers physical therapy. Without this required approval, the care is not covered.
People with Original Medicare pay 20% of the Medicare-approved amount for outpatient treatment, but cost-sharing requirements vary in Medicare Advantage Plans. Typically, plan members pay around $10 to $40 per appointment with in-network providers or more for out-of-network care.
How Much Would Physical Therapy Cost With Medicare?
Medicare helps make outpatient physiotherapy more affordable but does not pay the entire cost of beneficiaries’ treatments. People with Medicare are responsible for certain costs, including deductibles, coinsurance, and copayments.
The deductible is the amount beneficiaries pay out-of-pocket for covered services. The Part A deductible is $1,600 per hospital benefit period, and the Part B deductible is $226 per year. Medicare Advantage Plans can set different deductibles.
After meeting their plan’s deductible, beneficiaries pay a share of the cost of covered services. People with Original Medicare pay 20% of the Medicare-approved amount for outpatient treatment.
Without insurance, receiving physical therapy is cost prohibitive for many people. Outpatient treatment costs around $75 to $150 per session, depending on the location and treatment plan. An uninsured person who needs three sessions a week for eight weeks could pay $1,800 to $3,600.
Further Ways to Reduce Physical Therapy Costs
There are many ways for people with Medicare to lower their physical therapy costs even further. Some essential resources to consider include:
- Medicare Supplement Insurance (Medigap): Plans that help fill the gaps in Original Medicare by covering some or all of a person’s out-of-pocket costs. Each standardized plan helps cover the 20% coinsurance for Part B-covered physical therapy.
- State Medicaid Programs: Public assistance programs providing health coverage to low-income eligible people. When a person has both Medicare and Medicaid, Medicaid may help cover their out-of-pocket costs for physical therapy covered by Medicare.
- State Health Insurance Assistance Programs (SHIPS): Federally funded programs that provide free, one-on-one counseling to people with Medicare. SHIP counselors can help beneficiaries understand their physical therapy coverage and suggest cost-saving programs and strategies.
Physical Therapy vs. Other Forms of Care For Pain Management
Physiotherapy is not the only treatment option for people with chronic pain conditions. Medicare covers other treatments that beneficiaries may use alongside or instead of physical therapy.
Medicare Coverage | Criteria | |
---|---|---|
Physical Therapy | Medicare covers 80% of Medicare-approved amount | Must be medically necessary |
Acupuncture | Medicare covers 80% of the Medicare-approved amount | Only covered for chronic low back pain without a known cause |
Biofeedback Training Therapy | Medicare covers 80% of the Medicare-approved amount | Must be medically necessary, such as for muscle re-education |
Chiropractic Care | Medicare covers 80% of the Medicare-approved amount | Only covered to correct a vertebral subluxation |
Massage Therapy | Not covered | N/A, not covered |
Occupational Therapy | Medicare covers 80% of the Medicare-approved amount | Must be medically necessary |
TENS (Transcutaneous Electrical Nerve Stimulation) | Medicare covers 80% of the Medicare-approved amount for durable medical equipment | Covered for acute post-surgical pain or chronic pain |
How Each Form of Care For Pain Management Works
- Acupuncture: Acupuncture is an alternative treatment that involves inserting very thin needles into the skin. Original Medicare covers a maximum of 20 sessions per 12-month period to treat chronic low back pain. Some types of Medicare Advantage Plans offer broader acupuncture coverage.
- Biofeedback Training Therapy: The use of electrical sensors to help people learn to control their body’s functions. It’s covered under Medicare’s physical therapy benefit.
- Chiropractic Care: A therapeutic treatment that involves manipulating the spine. Original Medicare covers chiropractic care for vertebral subluxations, and some Medicare Advantage Plans cover it for other conditions.
- Massage Therapy: The use of touch and pressure to manipulate muscles and other soft tissues. Original Medicare does not cover massage therapy, so beneficiaries who want to try this treatment pay 100% of the cost. Some Medicare Advantage Plans cover massage therapy.
- Occupational Therapy: A therapy that helps people with health challenges find new ways to complete day-to-day tasks. Original Medicare covers medically necessary occupational therapy.
- TENS (Transcutaneous Electrical Nerve Stimulation): A treatment that sends electrical impulses through the skin to activate the nerves. Medicare covers TENS as durable medical equipment on a case-by-case basis.
Putting It All Together
Whether you need physical therapy to reduce pain after an injury, regain function after having surgery, or keep a chronic condition from worsening, Medicare is a valuable source of coverage.
Medicare coverage for physiotherapy varies depending on whether you have Original Medicare or Medicare Advantage and where you’ll receive your rehabilitation care. For details about how Medicare coverage for these services works, check your plan’s policy documents, call Medicare, or talk to a trusted agent.