Physical therapy can be necessary for many reasons. You might need physical therapy after surgery or need some physical therapy sessions after suffering a fall or injury.
These treatments are essential for regaining strength and mobility. However, physical therapy can be expensive, so many people wonder whether Medicare will cover it.
Keep reading if you have Medicare coverage and wonder whether your therapy services will be covered. We will give you all the details about Medicare and physical therapy, including which parts of Medicare might cover those healthcare expenses.
Does Medicare Cover Physical Therapy?
Generally, yes, Medicare covers physical therapy. The details can get a little confusing, though. Whether the therapy sessions are covered by Medicare Part A or Medicare Part B depends on a few factors. The location where you receive your therapy can also affect how Medicare pays for it.
So, what does Medicare cover when it comes to physical therapy? Here are the details you need to know about physical therapy, Original Medicare, Medicare Advantage plans, and Medicare supplement insurance.
KEY TAKEAWAYS
- Physical therapy is an essential part of recovery for many medical conditions and procedures and is generally covered by Medicare.
- Medicare does not have a therapy cap, meaning it will continue to pay for physical therapy sessions as long as your doctor deems them necessary.
- When your Medicare Part B covers the physical therapy, you are still responsible for your deductible and copay of 20%.
When Medicare Pays For Home Physical Therapy
Does Medicare pay for home health care physical therapy? Yes, there are several scenarios when Medicare will pay for physical therapy sessions in your home.
- While Medicare Part A covers physical therapy in the hospital during an inpatient stay or therapy services at an inpatient rehabilitation facility, it will also pay for certain home health services related to physical therapy after your release from the hospital.
To receive these home health benefits from Medicare Part A, your hospital stay must have lasted at least three days. If the physical therapy treatments are considered medically necessary after the hospital stay, Medicare Part A will cover the cost of physical therapy in your home.
- Medicare Part B covers physical therapy in your home as well. You already know that Part B covers necessary outpatient therapy services at outpatient rehabilitation facilities but will also pay for home health care physical therapy sessions.
However, a Medicare-certified home health care agency must be your therapy provider. Again, this physical therapy coverage is only in place when your doctor certifies that the physical therapy is medically necessary.
- So, necessary physical therapy will be covered at 80% of the Medicare-approved amount. Part B will also cover most of the durable medical equipment required for your therapy sessions.
Although Medicare Part D does not pay for your physical therapy, it can help pay for prescription drugs necessary for your therapy sessions. A Medicare Advantage health insurance plan likely includes prescription drug coverage that could be used in conjunction with your physical therapy coverage.
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Medicare Limits On Physical Therapy Sessions
So, are there any limits to the number of physical therapy sessions that Medicare will pay for? For example, some individuals with disabilities, like Parkinson’s disease, may need many more sessions than others who are treating an injury.
Thankfully, Medicare does not have a therapy cap. In the past, there was a limit to the number of sessions that would be covered each year, but this cap was eliminated in 2018. This means that Medicare will continue to pay for physical therapy sessions as long as your doctor deems them medically necessary.
Your doctor can authorize up to 30 days of physical therapy sessions. You cannot get blanket approval for therapy sessions that last indefinitely. After 30 days of physical therapy, your doctor must re-certify that the physical therapy is still medically necessary for treatment.
Your physician must re-author the sessions every 30 days for Medicare to continue paying for them. Failure to have your doctor re-authorize your physical therapy sessions will likely mean that Medicare will not pay for the sessions that were not authorized.
TIP
Long-term physical therapy can be pretty expensive. If you need physical therapy, you may consider Medigap coverage, which will help cover copays and possibly your deductible.
Cost Of Physical Therapy With Medicare
Medicare used to pay physical therapists based solely on the number of sessions and time spent with the patient at each session. If you are familiar with Medicare’s 8-minute rule, this would often apply to physical therapy sessions as well.
However, recently, Medicare has changed its payment method to a value-based approach. Therapists are now paid more based on the value they provide to the patient rather than purely on the amount of time spent with them. Medicare uses a complex formula to calculate these amounts.
The formula for determining how much you will owe out of your pocket for these sessions is simple.
- You are generally responsible for paying 20% of the Medicare-approved amount for each physical therapy session.
So, if the session costs $100, you must pay $20. Remember that if Medicare Part B provides the benefit, you must meet your annual Part B deductible before Medicare begins picking up the charges.
- You should know that physical therapy sessions are not cheap. Even with Medicare coverage, a physical therapy session might cost you anywhere from $40 to $200 out-of-pocket.
A Medigap plan can help cover these costs for individuals who need many sessions. Otherwise, these expenses can start to add up and become a financial burden to those who truly need those services. You can learn more about Medicare billing for physical therapy online.
The Bottom Line
Many people wonder, “Does insurance cover physical therapy?” The answer is usually yes, especially when talking about Medicare. Medicare Part A and Medicare Part B will cover physical therapy, depending on the nature of the treatment and where it is performed.
Part A generally covers inpatient physical therapy, while Part B covers outpatient treatment. Both parts of Medicare will pay for physical therapy in your home if specific requirements are met.
You should check your plan details for coverage specifics if you have a Medicare Advantage plan. Similarly, most Medigap plans should also help with your out-of-pocket expenses associated with your therapy sessions covered by Original Medicare.
Frequently Asked Questions
The Medicare payment depends on whether your physical therapy is covered by Part A or Part B. Generally, Part A will pay 100% of the Medicare-allowable charges.
This means that your “inpatient physical therapy” or physical therapy during your hospital stay should be covered at 100%. You will not owe any money out of your pocket for those services.
Part B services are covered at 80%. This means that you will owe 20% of the Medicare-approved amount when you receive physical therapy covered under Medicare Part B.
Yes, there is a deductible for physical therapy. However, the deductible is not specific to physical therapy. You can meet your deductible by paying for any Medicare-covered services.
Medicare Part A has an annual deductible of $1,632, while Part B has a deductible of $240. The deductible that you need to meet depends on whether your physical therapy sessions will be covered by Medicare Part A or Part B.
There is no limit to how often a Medicare beneficiary can receive physical therapy. There is also no limit to the number of sessions they may receive. However, the sessions must be deemed medically necessary by your doctor.
Your doctor may authorize up to 30 days of physical therapy at a time. After those 30 days, your doctor must re-authorize additional sessions. Failure to receive authorization for physical therapy might mean that your sessions are not covered.
Physical therapists generally help you perform stretches and certain exercises to strengthen specific muscles or parts of your body.
Chiropractic care, on the other hand, is more focused on manual manipulation of the spine to treat back or neck pain. While chiropractic care is covered by Medicare in some cases, very specific rules must be met to have chiropractic services covered.
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