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Does Physical Therapist Accept Medicare

cover physical therapy services, skilled nursing facilities
April 30, 2022

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What is covered by Medicare?

Physical therapy, referred to as 'PT' short for "Short", is the type of physical rehabilitation for improving mobility and pain. Medicare covers physical therapy if necessary. Depending on where this procedure is done, Medicare determines how much Medicare pays for these PTs. Physical therapy (or PT for short) is a kind of physical rehabilitation that is geared towards a variety of physical health concerns as well as how your body is working. Medications have been shown to be effective in improving quality of life and enhancing the mobility of people and reducing pain.

Medicare will cover 80 percent of medically necessary physical therapy costs, with no limit on outpatient physical therapy coverage. When an individual goes to a physical therapy session and expects to pay with Medicare, the physical therapy practice should issue them a notification if it is possible that Medicare will not cover the required physical therapy services. Under Medicare Part A for inpatient physical therapy in the hospital or a skilled nursing facility after a hospital stay.

Does Medicare Cover Physical Therapy?

Medicare can help pay for physical therapy (PT) that’s considered medically necessary. After meeting your Part B deductible, Medicare will pay 80 percent of your PT costs. PT can be an important part of treatment or recovery for a variety of conditions. It focuses on restoring functionality, relieving pain, and promoting increased mobility.

When does Medicare cover physical therapy?

Medicare Part B will help to pay for outpatient PT that’s medically necessary. A service is considered medically necessary when it’s needed to reasonably diagnose or treat a condition or illness. PT can be considered necessary to:

  • improve your current condition
  • maintain your current condition
  • slow further deterioration of your condition

For PT to be covered, it must involve skilled services from a qualified professional like a physical therapist or doctor. For example, something like providing general exercises for overall fitness wouldn’t be covered as PT under Medicare.

Your physical therapist should give you a written notice before providing you with any services that wouldn’t be covered under Medicare. You can then choose whether you want these services.

What Does Medicare Cover for Outpatient Rehabilitation Therapy?

Medicare covers three main types of outpatient rehabilitation therapy:

  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services

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Medicare Part B pays 80 percent of the Medicare-approved amount for outpatient therapy services received from a provider who accepts Medicare assignment. You are responsible for 20 percent of the cost after meeting the Part B deductible

Your costs for Medicare rehab coverage with a Medicare Advantage plan (Part C) depend on the specific plan you have. Medicare Advantage plans are offered by private insurance companies and approved by Medicare. These plans must provide coverage at least as good as what’s provided by Original Medicare (Parts A & B).

Is There a Limit on Medicare Coverage for Outpatient Therapy?

Technically, no. There is no limit on what Medicare will pay for outpatient therapy, but after your total costs reach a certain amount, your provider must confirm that your therapy is medically necessary in order for Medicare to cover it.

In 2022, your provider must confirm your therapy is medically necessary once your total costs reach $2,150 for physical therapy and speech-language pathology (combined total), or $2,150 for occupational therapy care. Original Medicare will continue to pay for up to 80 percent of the Medicare-approved amount once your care is confirmed as medically necessary. Your costs with a Medicare Advantage plan may be different, so ask your provider before seeking care.

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What if your physical therapy isn’t medically necessary? 

Your provider must notify you before providing care that is not medically necessary so you can decide whether you want the services. This is true for physical therapy, speech-language pathology, and occupational therapy. This notice is called an Advance Beneficiary Notice of Noncoverage (ABN). If your provider gives you an ABN, you may agree to pay for the services that aren’t medically necessary. However, Medicare may not help cover the cost.

Medicare covers physical therapy sessions so long as they are deemed medically necessary. There is no therapy cap on how much Medicare will cover for PT. However, keep in mind that treatment recommended by a physical therapy provider but not ordered by a doctor is not covered. In this situation, the therapist is required to give you a written notice, called an Advance Beneficiary Notice of Noncoverage or ABN, that Medicare may not pay for the service.

Where Can You Get Outpatient Therapy Services?

Medicare covers outpatient therapy services that you get from physical therapists, occupational therapists, speech-language pathologists, doctors, and other health care professionals. The services may be provided in the following locations:

  • A therapist’s or doctor’s office
  • A rehabilitation agency
  • A comprehensive outpatient rehabilitation facility (CORF)
  • A skilled nursing facility when you’re there as an outpatient
  • Your home, from certain therapy providers, when you’re not eligible for Medicare’s home health benefit

A special note about coverage in a skilled nursing facility or at home: The coverage rules for outpatient therapy above don’t apply if your therapy is part of a Medicare-covered stay in a skilled nursing facility or if you’re receiving home health care. You’ll need to contact your Medicare provider to understand how the costs and coverage rules apply for these situations, as they could vary.

Remember, if you need outpatient therapy care, make sure to always get confirmed proof from the care provider that the therapy is medically necessary. Nobody wants to get caught off-guard by extra costs later.

Outpatient physical therapy

Outpatient physical therapy services can be carried out in hospitals, private practice physical therapy clinics, doctors’ offices, and rehabilitation facilities to help treat a variety of different muscle, joint, and movement disorders. 

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