Does Medicare Cover Physical Therapy?

Yes, Original Medicare offers coverage for physical therapy when a physician deems it medically necessary.

Doctors can authorize up to 30 days of physical therapy at a time. However, if you need physical therapy beyond those 30 days, your healthcare provider must re-authorize it.

Suppose physical therapy occurs during or after a hospital stay. In that case, the cost is covered by Medicare Part A. Conversely, Medicare Part B covers outpatient or at-home physical therapy expenses.

Medicare ensures that individuals receive the necessary support and care for their physical therapy needs.

How Much Do I Pay?

Specifically, Medicare pays up to 80% of the Medicare-approved amount for physical therapy services, while the remaining 20% will be your out-of-pocket costs. You’ll also have to pay a yearly deductible before your Medicare coverage starts. A Medicare Supplement plan or Medicare Advantage Plan might prove beneficial in reducing out-of-pocket expenses and deductibles.

The number of sessions you can have covered will depend on several factors, such as your medical condition, the effectiveness and progress of the treatment, and your doctor’s recommendations.

What Are The Requirements To Receive Coverage?

Let’s dive deeper into the eligibility requirements.

To be eligible for Medicare coverage for physical therapy sessions:

• You must have a medical condition or injury that requires necessary physical therapy.
• A doctor must prescribe the therapy.
• The medical condition must be deemed “reasonable and necessary” by Medicare, which means that it must be a condition that can be improved or stabilized with physical therapy, such as strokes, arthritis, or chronic pain.

Medicare may not cover physical therapy treatment for conditions to maintain health or prevent further deterioration, such as general fitness or stretching.

How To Find Doctors That Accept Medicare

To start utilizing your Medicare coverage for physical therapy sessions, you must find a therapist who accepts Medicare. You can search for Medicare-approved physical therapists through the Medicare website or by calling 1-800-MEDICARE.

Be sure to let the therapist know you have Medicare coverage, as they must provide specific documentation to comply with Medicare regulations. During your first visit, the therapist will evaluate your condition and create a treatment plan that fits your needs and goals.

If you’re uncertain about your eligibility or have any questions on how to get started, reach out to your doctor or insurance plan provider for guidance on your care plan. Also, be sure to ask questions and voice any concerns you might have throughout the treatment process.

Bottom Line

In conclusion, Medicare provides coverage for physical therapy sessions, up to a certain extent, for eligible medical conditions that can benefit from physical therapy.

The number of sessions covered will vary based on various factors, and you’ll typically need a doctor’s prescription and a Medicare-approved physical therapist.

Don’t let the cost hinder accessing the necessary treatment to enhance your quality of life. You can reduce out-of-pocket expenses and deductibles with a Medicare Supplement plan or Medicare Advantage Plan.

Sources: Medicare.gov – AARP.org – WebPT.com – GoodRX.com

FAQs

• Does Medicare cover physical therapy for osteoporosis?

  Yes, Medicare Part B includes coverage for medically necessary outpatient physical therapy services, including osteoporosis-related treatments, when rendered by a healthcare professional who accepts Medicare.

• Does Medicare cover physical therapy for chronic back pain?

  Yes, Medicare Part B provides coverage for physical therapy services that are medically necessary to treat chronic back pain. As your physician advises, these treatments may include exercise, stretches, and other techniques.