How many physical therapy sessions are covered by medicare

Your doctor may prescribe Medicare physical therapy for many different reasons. According to the American Physical Therapy Association, physical therapists help restore normal physical function and help prevent impairments, disabilities, and functional limitations resulting from injuries, diseases, and other conditions.

Physical therapy is care that evaluates and treats injuries or diseases that change your ability to function, and helps to improve or maintain current function that may be declining. If you need physical therapy and you’re wondering what your Medicare physical therapy costs are, this article will help you understand your coverage.

Medicare physical therapy coverage:

Medicare Part A

Medicare will only cover services deemed “reasonable and necessary”. When it comes to physical therapy coverage, Medicare Part A can cover some of the costs for inpatient or at home services such as rehab centers or skilled nursing facilities.

Medicare Part B

For physical therapy services, Medicare Part B covers medically necessary services certified by an approved doctor or physical therapist. This coverage could include: outpatient therapy, occupational therapy, physical therapy and other forms of outpatient therapy meant to alleviate, treat, or prevent conditions. This also can include care at skilled nursing facilities or at home care.

Medicare Advantage

As long as you meet your Medicare Part B deductible, Medicare Advantage can cover 80% of your physical therapy costs when you cover the remaining 20%. This only applies if your physical therapy is medically necessary.

Medicare Supplement Insurance Plans (Medigap)

For coverage that Medicare Part A and Part B may not cover, Medicare Supplement (Medigap) plans come in to help merge that gap. Medigap can cover what Medicare plan options cover which includes the 20% coinsurance and may pay your Medicare Part B deductible.

What are Medicare physical therapy benefits?

Generally speaking, Medicare helps pay for any medically necessary physical therapy services your doctor orders to treat your condition. However, your Medicare physical therapy benefits depend, in part, on where you get services.

What is the Medicare deductible for physical therapy?

Medicare Part B generally covers physical therapy services. If you get physical therapy at the hospital, an outpatient center, or in your doctor’s office, Part B typically covers 80% of allowable charges after you meet your Part B deductible. These benefits are the same for other medically necessary therapies such as occupational therapy and speech language therapy.

However, if you need physical therapy services at home, your Medicare Part A and/or Part B home health benefits may cover 100% of the allowable charges. In order to get Medicare physical therapy benefits at home, you must meet all of the following conditions:

• You must be under a doctor’s care, and your physical therapy must be part of a care plan that is regularly reviewed by your doctor.
• You must be certified homebound by your doctor.
• The physical therapy treatments must be performed by a qualified physical therapist. If you need help finding a physical therapist who accepts Medicare in your area, you can use the Medicare Physician Compare tool.
• The home health agency providing the services must be certified by Medicare.
• Your doctor believes that your condition can reasonably be expected to improve with physical therapy, or you need physical therapy to maintain your condition and keep it from worsening.

Does Medicare cover physical therapy equipment?

Medicare physical therapy benefits generally won’t cover home health services that are more than part-time or intermittent in nature.

If you qualify for physical therapy home health care, you pay nothing for your therapy, and just 20% of the allowable charges for any durable medical equipment you may need as part of your treatment.

Does Medicare cover physical therapy for back and neck pain?

Medicare can cover many diagnostic tests, surgery, physical therapy, and prescription drugs when it comes to back and neck pain. Medicare Advantage plans can potentially cover wellness programs to help with your back and neck pain. Alternatively, Medicare does not cover chiropractic care.

What are Medicare physical therapy caps?

In the past, Medicare imposed an annual limit, or cap, on the amount of therapy services you could get in any calendar year. The costs for physical therapy, occupational therapy, and speech language pathology all contributed to your annual therapy cap.

However, as of 2018, Congress eliminated the therapy caps. There is no longer a specific limit on the amount of physical therapy services you can receive in a calendar year, but your health care provider will have to provide extra information in your medical record when your therapy charges reach a certain amount.

• $2,150 for physical therapy and speech language pathology services combined
• $2,150 for occupation therapy services

Once you hit this amount, your doctor will need to note why the services are reasonable and medically necessary.

If you continue to get physical therapy or other therapy services beyond this amount, your claim may be reviewed by Medicare once the amount reaches $3,000 for either physical therapy and speech language pathology, or occupational therapy. If Medicare determines that your doctor hasn’t provided enough information to justify continued therapy, Medicare may decide not to cover any additional services.

If this happens, your health care provider or physical therapist must give you a notice explaining that Medicare may not cover additional services that aren’t considered medically necessary for your treatment. This notice is called an Advance Beneficiary Notice of Noncoverage (ABN). If you get an ABN from your provider, you can either end your physical therapy, or continue with your treatments understanding that you agree to pay for them yourself.

What are Medicare Physical Therapy benefits with Medicare Advantage plans?

If you have a Medicare Advantage plan, your Medicare physical therapy benefits may be slightly different. Medicare Advantage plans must provide the same level of benefits as Original Medicare, at a minimum. However, because these plans are offered by private insurance companies, they are free to offer extra benefits in addition to those under Part A and Part B. If you have a Medicare Advantage plan, check with your plan administrator or your plan documents to see how it covers physical therapy.

Estimating your out-of-pocket costs

To get an idea of what your estimated costs could be when using Medicare insurance physical therapy coverage, here are a few things to keep in mind:

• Contact your physical therapist to help estimate the cost of treatment
• Check with your insurance provider or one of eHealth’s licensed agents for assistance and help with answering your Medicare insurance questions
• Compare estimates to get an idea of potential costs that factor in your copay, deductible, or other out-of-pocket costs.

How many weeks does Medicare pay for physical therapy?

Does Medicare cover physical therapy in 2022?

Does Medicare have a lifetime limit on physical therapy?

What is the Medicare therapy cap for 2022?