Does Medicare Cover Physical Therapy?

# Does Medicare Cover Physical Therapy?

Physical therapy is one of the most commonly needed services among Medicare beneficiaries — whether recovering from a joint replacement, managing a neurological condition, or regaining strength after a hospitalization. Medicare does cover physical therapy, but the details matter: where you receive care, how your doctor documents medical necessity, and whether you have supplemental coverage all affect your out-of-pocket experience.

How Part B Covers Physical Therapy

Medicare Part B covers outpatient physical therapy when it is deemed medically necessary by your doctor or treating therapist. This means therapy must be prescribed to treat an illness, injury, or functional decline — not purely for general fitness or wellness. Your doctor or therapist must document that your condition requires skilled care and that you are making, or are expected to make, meaningful progress.

Covered settings include:

• Outpatient hospital departments
• Independent physical therapy offices
• Physician offices that employ therapists
• Outpatient rehabilitation facilities

Part B pays 80 percent of the Medicare-approved amount after you meet the annual Part B deductible. You are responsible for the remaining 20 percent coinsurance. If you have a Medicare Supplement (Medigap) policy, it may cover some or all of that coinsurance depending on which plan you hold. For exact current figures on the Part B deductible and approved amounts, visit Medicare.gov or call 1-800-MEDICARE.

The Therapy Threshold and Documentation Requirements

There is no longer a hard annual dollar cap on physical therapy under Medicare — that cap was permanently repealed. However, once your therapy costs cross a certain threshold in a calendar year, a medical review requirement kicks in. At that point, your therapist must include a functional reporting code and a targeted medical review may be triggered to confirm that continued therapy remains medically necessary.

This does not mean therapy stops at the threshold. It means the documentation bar becomes more rigorous. Your therapist will track your functional goals and progress notes carefully to support continued coverage. Staying in close communication with your care team about your goals and progress is the best way to ensure the documentation supports ongoing authorization.

If you are an inpatient at a hospital or skilled nursing facility, your physical therapy there falls under Part A rather than Part B. Part A covers inpatient rehabilitation as part of the broader inpatient stay benefit. The coverage rules, copays, and duration limits differ from outpatient Part B therapy, so it is worth understanding which part applies to your situation.

Home Health and Skilled Nursing Facility Therapy

Sometimes physical therapy is delivered in the home. Medicare home health benefits can cover physical therapy provided by a Medicare-certified home health agency if you are homebound and your doctor certifies that you need skilled care. Home health physical therapy falls under Part A or Part B depending on the circumstances, and there is no cost-sharing for covered home health services if all conditions are met.

After a qualifying hospital stay of at least three days, Medicare Part A may also cover physical therapy in a skilled nursing facility (SNF). Coverage in an SNF follows a day-based structure — the amount Medicare pays and what you owe changes as your stay lengthens. Contact Medicare.gov for the current SNF daily cost-sharing amounts, as these figures update each year.

If you are on a Medicare Advantage plan, your plan must cover at least everything Original Medicare covers, but may have different cost-sharing, network requirements, or prior authorization rules for physical therapy. Always check your plan's Evidence of Coverage before beginning a course of therapy.

What Is Not Covered

Medicare will not cover physical therapy that is:

• Purely maintenance-level care with no expectation of functional improvement (though the Jimmo v. Sebelius settlement clarified that maintenance therapy can be covered if skilled care is required to maintain function or prevent decline — an important distinction)
• Not prescribed by a physician or authorized practitioner
• Provided by a non-Medicare-certified therapist or facility
• Primarily for general fitness or wellness rather than treatment of a medical condition

Keeping your therapy goals clearly tied to a diagnosed condition and working with a Medicare-enrolled provider are the two most important steps to making sure your care is covered.

Frequently Asked Questions

Q: Is there a limit on how many physical therapy visits Medicare will cover? A: There is no hard visit limit or annual dollar cap for outpatient physical therapy under Part B. However, once your therapy spending crosses a certain threshold in a year, additional documentation is required to confirm medical necessity. Your therapist tracks this and adjusts documentation accordingly.

Q: Does Medicare cover physical therapy at home? A: Yes, in certain circumstances. If you are homebound and your doctor certifies a need for skilled care, a Medicare-certified home health agency can provide physical therapy at home with no cost-sharing for the covered home health benefit. The homebound requirement and other conditions must be met for coverage to apply.

Q: Do I need a referral for physical therapy under Medicare? A: Part B generally allows you to see a physical therapist without a physician referral, but you do need a plan of care certified by a physician or other authorized provider. Some Medicare Advantage plans have their own referral or prior authorization requirements, so check your specific plan's rules before scheduling.

Have questions about your Medicare options? Lynsey Brennan (FL License #G007269) offers free consultations in FL, TX, AZ, GA, NC, SC, PA, OH, TN, VA. Call (561) 735-1490 or book online.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.