Physical therapy is a vital part of recovery for many individuals, whether it’s due to an injury, illness, or surgery. But does Medicare cover physical therapy? In this article, we’ll explain how Medicare covers physical therapy services, the costs involved, and the eligibility requirements. This information will help you understand what Medicare covers and how to access the therapy services you need.
Medicare is a federal health insurance program that primarily serves people over the age of 65, as well as some younger individuals with disabilities. The program is divided into different parts, each covering various aspects of healthcare. Understanding these parts will help you know how physical therapy fits into the coverage.
Medicare Part A covers inpatient care like hospital stays, skilled nursing facilities, and hospice care. These types of inpatient stays are covered under Part A, including hospital admissions and care in inpatient rehabilitation facilities. If you’re admitted to a hospital or skilled nursing facility, Medicare Part A can cover physical therapy services related to your inpatient care.
Medicare Part B covers outpatient services, including outpatient physical therapy. This is the most common coverage for physical therapy, as it applies to therapy you receive at a doctor’s office, outpatient clinic, or in your home if you qualify for home health care. Medicare covers outpatient physical therapy provided in the home setting through home health care if you meet the eligibility requirements.
Medicare does cover physical therapy services, but certain conditions must be met for coverage. Coverage is provided only if the physical therapy qualifies as a medically necessary service under Medicare guidelines.
Medicare Part B helps cover outpatient therapy services that are deemed medically necessary by your healthcare provider. These services must be provided by a physical therapist who accepts Medicare. Doctors, as well as physical therapists and other specialists, can be involved in providing outpatient therapy services.
The therapy must be required to treat or manage a medical condition or injury. It can also be used to maintain your current condition or slow further deterioration of your health.
Medicare will cover outpatient PT (physical therapy) if:
Not everyone automatically qualifies for Medicare-covered physical therapy. Here’s what you need to know about eligibility and the process. Eligibility for Medicare-covered physical therapy also depends on whether the therapy meets accepted standards of medical practice.
To qualify for physical therapy under Original Medicare, you need to meet these criteria:
Medicare covers skilled therapy services such as physical therapy, occupational therapy, and speech-language pathology services. These services must be provided by qualified professionals, including physical therapists, occupational therapists, and speech therapists. To be covered by Medicare, skilled therapy services must meet accepted standards of medical practice.
Physical therapy must be deemed medically necessary. This means that the therapy is needed to diagnose or treat a medical condition. For example, if you’re recovering from a surgery or managing a chronic condition, physical therapy may be necessary to help restore or maintain mobility.
While Medicare covers physical therapy, there are still costs that you may need to pay out-of-pocket. Medicare’s payment for therapy services is subject to specific rules and thresholds, which determine how much is covered and when providers must verify medical necessity for reimbursement.
Once you meet the Part B deductible (which is $257 for 2025), Medicare Part B will typically cover 80% of the Medicare-approved amount for physical therapy. Medicare pays this 80% directly to the provider. You will be responsible for the remaining 20% coinsurance. The exact amount you owe may depend on the type of therapy and where it’s provided.
There can be additional costs that you may need to pay, including:
Medicare used to limit the amount it would pay for outpatient therapy services, but this therapy cap was removed in 2018. Now, Medicare provides coverage for outpatient therapy services within each calendar year as long as the therapy is medically necessary. However, if your therapy costs exceed a certain amount (around $2,410 in 2025), your healthcare provider must document that the therapy is still medically necessary for Medicare to continue covering it.
If you’re enrolled in a Medicare Advantage plan (Part C), your coverage for physical therapy may differ from Original Medicare. Original Medicare covers outpatient physical therapy services under Part B, including medically necessary treatments prescribed by your doctor.
Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. These plans are administered by private companies, which are responsible for providing coverage and managing benefits. These plans provide the same coverage as Original Medicare (Parts A and B), but they may offer additional benefits, including coverage for outpatient rehabilitation and language therapy.
Some Medicare Advantage plans may have lower out-of-pocket costs for therapy services, while others may offer additional coverage for therapies not covered by Original Medicare. Be sure to check your plan details to understand exactly what’s included. For the most accurate and up-to-date information about therapy coverage and costs, consult your plan’s summary.
To get physical therapy under Medicare, you must find a physical therapist who accepts Medicare. You can ask your doctor for a referral or search online for a Medicare-approved provider.
Your doctor or therapist must provide the necessary documentation to show that your therapy is medically necessary. If your therapy costs exceed the therapy threshold, your provider must submit extra documentation to Medicare to confirm that the treatment is still needed.
In addition to physical therapy, Medicare Part B also covers other therapy services, such as occupational therapy and speech-language pathology. These services help patients regain functional skills after injuries or manage conditions like stroke or Parkinson’s disease.
If you’re concerned about the out-of-pocket costs associated with physical therapy, there are ways to manage these expenses.
If you’re enrolled in Original Medicare, you may want to consider a Medigap (Medicare Supplement) policy. Medigap plans help cover costs that Original Medicare doesn’t, such as coinsurance, deductibles, and copayments.
A Medicare Advantage plan may offer lower out-of-pocket costs for physical therapy and could provide additional benefits, such as coverage for prescription drugs and preventive services. When comparing Medicare Advantage plans, make sure to review the details on therapy coverage to ensure that it meets your needs.
Medicare covers medically necessary physical therapy under Part B, but it’s essential to understand the costs and eligibility requirements. If you have additional needs, such as speech-language pathology or occupational therapy, Medicare provides coverage for those services as well. Depending on your situation, Medicare Advantage plans or Medigap may help reduce out-of-pocket costs. Be sure to work with your healthcare provider to confirm that your therapy services meet Medicare’s requirements and understand your financial responsibilities.
If you’re unsure about your coverage, reach out to Flagstar Rehab for guidance on accessing Medicare-covered therapy services and connecting with the right providers for your needs.
Medicare does not limit the number of physical therapy sessions it will cover. However, if the total cost of therapy exceeds $2,410 in 2025, your provider must submit documentation showing the therapy is still medically necessary for Medicare to continue paying.
Medicare may deny physical therapy if it is not deemed medically necessary, if the provider is not Medicare-approved, or if you exceed the $2,410 threshold without providing sufficient documentation. Therapy may also be denied if the provider is out-of-network.
Medicare generally covers 80% of the Medicare-approved amount for physical therapy after you meet the Part B deductible. You are responsible for the remaining 20%. If the provider charges more than the Medicare-approved amount, you will need to pay the difference.