Does Medicare Cover Physical Therapy?

Original Medicare includes coverage for "medically necessary" physical therapy.
John RossheimMar 3, 2021

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Medicare covers much of the cost of physical therapy when it’s medically necessary. And it often is necessary for people age 65 and older. In 2019 nearly 3 million Medicare beneficiaries received PT for injury or illness or during surgical recovery, to reduce pain and increase mobility.

What coverage does Original Medicare provide for physical therapy?

Medicare Part B covers 80% of charges for outpatient physical therapy after you pay the deductible, which is $203 for 2021. You’ll be billed for a 20% copayment.

Note: In Medicare speak, “medically necessary” means: “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”

If physical therapy charges exceed $2,010, Medicare may require your health care provider to document the need for further treatment.

To qualify for coverage of physical therapy provided at your home under Original Medicare, a number of conditions must be met. Among them: A doctor must certify that you are homebound, and you must be under the care of a doctor who is treating you according to a care plan. The prescribed physical therapy must require that a therapist be present to make the treatment safe and effective.

Does Medicare cover inpatient physical therapy?

Medicare Part A covers some of the costs of inpatient physical therapy provided at a facility such as an acute care rehabilitation center or rehabilitation hospital. You may have to pay a total deductible of up to $1,364 for your first 60 days of physical therapy provided in inpatient rehab. For days 61 to 90, your costs skyrocket to a coinsurance payment of $341 per day; from day 91, you pay $682 per day.

Can Medigap or Medicare Advantage provide greater coverage?

You may be able to reduce or eliminate Original Medicare’s 20% copay for outpatient physical therapy if you choose another form of Medicare. Check with your Medicare Advantage or Medigap (Medicare supplemental insurance) plan to see if it will reduce your out-of-pocket cost for physical therapy.

Questions to ask your physical therapist

  • How many physical therapy sessions will my course of treatment require?

  • What is the charge for each physical therapy appointment?

  • In case total charges exceed $2,010, will you have submitted documentation to Medicare to ensure that my treatment can continue uninterrupted?

Frequently asked questions

Physical therapists must bill for their services in quarter-hour increments, and the so-called “8-minute rule” dictates how to round up or down for sessions of a duration that isn’t a multiple of 15 minutes (15, 30, 45, etc.).

If a session is 8 minutes or more beyond a multiple of 15, then it is rounded up. For example, a 38-minute session will be rounded up to 45 minutes for billing. If a session is 7 minutes or less beyond a multiple of 15, then it is rounded down. So if a session is 37 minutes, it will be rounded down for billing purposes.

If you have questions about your bill, you can ask your physical therapist or their office staff to explain it to you — and you deserve that explanation.

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