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Medicare Coverage for Physical Therapy

Physical therapy is any type of therapy that is applied physically. It could include massage, exercise and stretching among other techniques to help with an injury or health problem. It is different than other medical interventions in that it does not use drugs or surgery to fix problems. Those who have health problems that could be remedied by physical therapy may wonder if Medicare will cover it. Medicare is the American health care program for adults age 65 and older, those who have been on disability for more than 2 years and anyone who is in end-stage renal failure. It is an important program to help people who cannot otherwise work or get health care coverage.

Does Medicare Cover Physical Therapy?

Medicare does cover some physical therapy, but it must be deemed medically necessary in order to get covered. As physically therapy is an outpatient procedure, typically, it gets covered under Medicare Part B. You will usually do these services for a short period time or on an intermittent schedule. Under Medicare Part B you pay just 20% of the cost of these services, after you have paid any deductible. However, you should know that there are some coverage caps for Medicare physical therapy coverage. Physical therapy and speech pathology therapy have a combined cap of $1960. Occupational therapy has a separate cap of the same amount.

If you reach your cap but your doctor says therapy is still medically necessary, you may be able to get an exception so that Medicare will still cover it. There are quite a few times when you might want to get physical therapy that is not deemed medically necessary. In this case you would need to sign something with the physical therapist stating that you understand that you will not have coverage and that you will be paying for the therapy.

If you want help paying for the deductible or coinsurance associated with any physical therapy sessions, it is recommended to try a Medigap plan. This will cover you for different things depending on the type of plan you get. It can help to cover your deductible or coinsurance if you want to get it.

What Is Medically Necessary Physical Therapy

Medically necessary physical therapy is something in which there are a few goals to be reached. First of all, someone with authority deems it is medically necessary. This is usually a doctor or another medical professional. The therapy will minimize damage to the body. The therapy is not for convenience, it is for a medical purpose and the therapy has been shown to help whatever problem you are suffering from. These qualities will make it so that you can get medically necessary physical therapy covered by Medicare.

So, if you get physical therapy you can rest assured that Medicare will cover at least some of it if it is deemed medically necessary. However, that definition can be somewhat subjective so if you need to get physical therapy in your opinion you may want to advocate for yourself and find a physician who may find it necessary.