How many physical therapy sessions does medicare pay for

Learn if Original Medicare covers physical therapy.

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Does Medicare Cover Physical Therapy?
Does Medigap Cover Physical Therapy?
Does Medicare Advantage Cover Physical Therapy?
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What inpatient physical therapy does Medicare cover?
What outpatient physical therapy does Medicare cover?
In what settings does Medicare a cover PT services?
How often should you go to physical therapy?
What is the Medicare cap for 2022?
How Long Does Medicare pay for physical therapy after knee replacement?

Last Updated: Sep 07, 2022 12:22 pm

Physical Therapy is an alternative treatment before and after surgery to help heal and prevent further injury, as well as care after a serious illness such as a stroke. Physical therapy costs can really add up, especially if you need care for a long period of time. So does Medicare cover it and how much does it cover?

Does Medicare Cover Physical Therapy?

Yes. Medicare covers physical therapy. At one time there was a maximum payout for physical therapy but it was removed by Congress in 2018. Now Medicare Part B helps pay 80% of medically necessary outpatient physical therapy.

You are still responsible for your Medicare Part B deductible, your 20% coinsurance and any excess charges.

Does Medigap Cover Physical Therapy?

All Medigap plans pay for all or part of your physical therapy coinsurance and copays. However, only Medigap Plans C and F cover your Part B deductible. Plan F and Plan G will cover all excess charges as well.

Does Medicare Advantage Cover Physical Therapy?

Medicare Advantage (MA) does cover physical therapy. However, since MA plans are not standardized each plan can cover it differently.

For further questions call a Senior65 agent at 800-930-7956 or click here to read our article Does Medicare cover Chiropractic and Acupuncture?

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Medicare Part B covers outpatient therapy, including physical therapy (PT), speech-language pathology (SLP), and occupational therapy (OT). Previously, there were limits, also known as the therapy cap, how much outpatient therapy Original Medicare covered annually. However, in 2018, the therapy cap was removed.

Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. When you receive services from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible ($233 in 2022).

If your total therapy costs reach a certain amount, Medicare requires your provider to confirm that your therapy is medically necessary. In 2022, Original Medicare covers up to:

$2,150 for PT and SLP before requiring your provider to indicate that your care is medically necessary
And, $2,150 for OT before requiring your provider to indicate that your care is medically necessary

Remember, Medicare pays for up to 80% of the Medicare-approved amount. This means Original Medicare covers up to $1,720 (80% of $2,150) before your provider is required to confirm that your outpatient therapy services are medically necessary. If Medicare denies coverage because it finds your care is not medically necessary, you can appeal.

Keep in mind that outpatient therapy includes therapy received:

At therapists’ or doctors’ offices
At Comprehensive Outpatient Rehabilitation Facilities (CORFs)
At skilled nursing facilities (SNFs), when you are there as an outpatient or are otherwise ineligible for a Medicare-covered stay
And, at home through therapists connected with home health agencies, when you are ineligible for Medicare’s home health benefit

Medicare’s coverage rules for outpatient therapy do not apply if you are receiving therapy as part of a Medicare-covered SNF stay or if you are receiving Medicare-covered home health care.

En español | Yes. Medicare covers physical therapy that’s considered medically necessary to treat an injury or illness, such as to manage a chronic condition like Parkinson’s disease or aid recovery from a fall, stroke or surgery. Medicare also covers:

Occupational therapy, which helps with daily living activities, such as bathing, dressing and eating.
Speech-language pathology, which provides evaluation and treatment to regain and strengthen speech and language skills.

What inpatient physical therapy does Medicare cover?

Medicare Part A covers inpatient stays in hospitals, skilled nursing facilities and some home care, as well as physical therapy at inpatient rehabilitation facilities. It may also cover in-home services if you’re eligible for home care or services you receive at a skilled nursing facility after a three-day hospitalization.

Your out-of-pocket costs, such as deductibles and coinsurance, depend on the treatment setting. For example, your share of the cost is different if you receive inpatient care in a hospital vs. a skilled nursing facility.

What outpatient physical therapy does Medicare cover?

If you require skilled therapy services, Medicare covers outpatient therapy services, including occupational therapy, physical therapy and speech-language pathology. But your doctor or therapist must create and regularly review the care plan.

Medicare Part B will cover outpatient physical therapy once you pay the annual Part B deductible for doctor and outpatient services, which is $233 in 2022. You’ll also pay 20 percent of the Medicare-approved amount for outpatient occupational therapy, physical therapy and speech-language pathology received at:

A doctor’s or therapist’s office.
A hospital outpatient department.
An outpatient rehabilitation facility.
A skilled nursing facility if you’re being treated as an outpatient or are ineligible for a Medicare-covered stay.
Home if a Medicare-certified home health agency provides care and you’re ineligible for Medicare Part A home health benefits.

Keep in mind

Medicare previously set an annual maximum payment for outpatient therapeutic services but eliminated that cap in 2018. While the program no longer limits what it will pay yearly for medically necessary therapy, if your total therapy costs reach a certain amount within a year, your provider must confirm that the therapy is medically necessary. In 2022, that amount is $2,150 for physical therapy and speech language pathology combined, and $2,150 for occupational therapy.

Updated September 13, 2022

In what settings does Medicare a cover PT services?

If you have original Medicare, Part A will pay 100% of the PT bill after you've paid your $1,556 annual deductible in 2022..

Hospital or acute-care rehabilitation center..

Skilled nursing facility..

Or at home after a 3-day hospital stay..

How often should you go to physical therapy?

How long does physical therapy treatment take? A typical order for physical therapy will ask for 2-3 visits per week for 4-6 weeks. Sometimes the order will specify something different. What generally happens is for the first 2-3 weeks, we recommend 3x per week.

What is the Medicare cap for 2022?

In 2022, Original Medicare covers up to: $2,150 for PT and SLP before requiring your provider to indicate that your care is medically necessary. And, $2,150 for OT before requiring your provider to indicate that your care is medically necessary.

How Long Does Medicare pay for physical therapy after knee replacement?

Medicare covers inpatient rehab in a skilled nursing facility – also known as an SNF – for up to 100 days. Rehab in an SNF may be needed after an injury or procedure, like a hip or knee replacement.