Yes, Medicare covers physical therapy, among other therapies, provided it is determined to be medically necessary. In other words, it must be required to treat a condition or illness, and it must be certified as necessary by a doctor.
Who is eligible for physical therapy under Medicare?
Anyone who has Medicare Part B will have their physical therapy costs covered—as long as Medicare finds the services medically necessary and reasonable. Medicare considers a service medically necessary if it is needed to diagnose or treat an illness or condition and meets accepted standards of medicine. It must also be prescribed by a doctor.
To be eligible for Medicare Part B, you must be 65 or older and meet at least one additional requirement:
- You currently receive Social Security benefits.
- You are disabled and receive disability benefits.
- You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
Medicare Advantage plans also cover physical therapy, since they are required to cover everything Medicare Part A and Part B covers. There may be additional benefits with some Medicare Advantage plans, and your costs may differ from Original Medicare. So be sure to double-check your plan’s details with your provider.
Are there limits for physical therapy with Medicare?
There is an annual limit of $1,980 for physical therapy.1 This limit is also shared with speech therapy, so if you need both as part of your treatment, they will both count towards the limit. If you only need physical therapy, though, you can rely on the full $1,980 for your physical therapy.
Should you require more than $1,980 of physical therapy, you may be eligible for a therapy cap exception. You’d have to go through the exceptions process to exceed the limit, and it must be determined that the additional therapy is medically necessary. This exception increases your limit to $3,700 per year, known as the therapy cap limit.2 If you exceed that threshold, Medicare may review your medical records again to verify the therapy is necessary.
How much does physical therapy cost under Medicare?
Patients pay 20% of the Medicare-approved amount for therapy. Since these services are covered under Part B, the Part B deductible also applies. In 2017, the Part B deductible is $183 per year.3 That means you’ll need to pay $183 out of pocket each year before Medicare will start paying its portion of the costs.
If you have a Medicare Advantage plan instead of Original Medicare, your costs will depend on the specific plan you select—you can contact your plan provider for details.
Does Medicare cover physical therapy at home?
Yes, Medicare will cover physical therapy at home if it is medically necessary. Medicare covers a variety of home health care services, including physical therapy, although they are usually covered under Part A rather than Part B.
What other types of therapy does Medicare cover?
Medicare actually covers several types of therapy:
- Physical therapy: This therapy is designed to help the patient improve balance, strength, flexibility, and other areas of physical ability. Physical therapy might be used after an injury or surgery to help the patient regain normal functionality.
- Speech therapy: Also known as speech-language pathology, speech therapy treats a wide range of speech and voice challenges, including trouble finding the right words, creating meaningful and grammatically correct sentences, and using the proper volume when speaking.
- Occupational therapy: Occupational therapy focuses on helping people improve or regain skills necessary for daily living. This is a broad category of therapy and includes therapy for activities of daily living like bathing and dressing, for skills needed to get and keep a job, and for social skills.
There is a separate annual limit of $1,980 for occupational therapy, in addition to the limit on physical and speech therapy.4 This is useful if you need to have multiple types of therapy to treat your condition—it effectively doubles your annual limit in those cases.
Any therapy you need must be certified as medically necessary for Medicare to pay for it. Some therapy services may not be considered medically necessary but may still be recommended by your doctor. In this case, the therapy provider is required to give you advance notice that the services will not be covered.
We hope this article has answered your questions about physical therapy and Medicare. If you need more information on Medicare coverage and benefits, check out our in-depth FAQ pages that have answers to a range of common Medicare questions.
1Medicare.gov, “Physical Therapy/Occupational Therapy/Speech-Language Pathology Services”
2Medicare.gov, “Physical Therapy/Occupational Therapy/Speech-Language Pathology Services”
3Medicare.gov, “Part B Costs”
4Medicare.gov, “Physical Therapy/Occupational Therapy/Speech-Language Pathology Services”