Whether it be through stretching, massage, heat treatment, or guided exercise, attending appointments for physical therapy can make a significant difference in overall quality of life.  

Medicare helps to pay for a variety of medical and hospital needs so you may find yourself wondering about Medicare coverage of physical therapy. Let’s take a look and see how Medicare and physical therapy work for your healthcare needs.  

Does Medicare pay for physical therapy? 

Yes, Medicare will help you cover the costs of your physical therapy appointments. There are some Medicare limits on physical therapy but you should be able to get some help with payments as long as you have Part B and the therapy is prescribed by a doctor.  

Does Medicare Part A cover physical therapy? 

Medicare Part A does not cover outpatient or in-home physical therapy. It will help cover the costs of physical therapy received in hospitals, Medicare-approved skilled nursing facilities, and inpatient rehabilitation facilities. It will not cover physical therapy sessions after your hospital stay ends.  

Does Medicare Part B cover physical therapy? 

Medicare Part B physical therapy coverage does apply to outpatient sessions so long as they are deemed medically necessary by a doctor. This means your Medicare Part B will be the plan that covers physical therapy outside of the hospital. There is no limit to how much Part B will cover so long as the sessions continue to be medically necessary. After meeting your Part B deductible, you will be responsible for 20% of the cost of your physical therapy sessions. 

Does Medicare Advantage cover physical therapy? 

Medicare Advantage, or Plan C, does cover physical therapy sessions. Your out-of-pocket costs will depend on which Medicare Advantage plan you have as well as where you get your physical therapy services and the specific circumstances of your condition.  

With Part C, or Medicare Advantage, you will need to meet the same eligibility requirements as Original Medicare, or Part A and Part B, to qualify for coverage of your physical therapy services. It’s important to check with your plan to see what your coverage options are and what you can expect for out-of-pocket costs.  

Medicare physical therapy guidelines 2024 

Do I need a referral for physical therapy under Medicare?

Yes, you do need a referral for Medicare physical therapy coverage. The sessions must be deemed medically necessary by your doctor and you will need to provide a referral for your Medicare coverage to help pay for the costs.  

How many physical therapy sessions does Medicare cover? 

There is no limit on the number of physical therapy sessions Medicare Part B covers. However, you must meet your Part B deductible before Medicare starts to cover costs. Once you meet your deductible you will be responsible for 20% of the cost of the Medicare-approved amount.  

Costs per physical therapy session with Medicare coverage will depend on a few factors including: 

• Your supplemental insurance coverage 
• The full cost charged by your doctor 
• The facility you receive your physical therapy at 
• Whether or not you’ve met your deductible 

Does Medicare cover home physical therapy? 

Medicare does cover home services so long as they are referred by your doctor. You must also be homebound for medical reasons to be eligible for full in-home physical therapy Medicare coverage. There are some eligibility requirements to receive Medicare coverage for home services (including physical therapy): 

• Be under a doctor’s care plan for services and treatments 
• Be homebound for medical reasons 
• Have physical therapy referrals from your doctor under your care plan 

Medicare guidelines for physical therapy in skilled nursing 

Medicare Part A covers inpatient care in hospitals and skilled nursing facilities. Medicare will cover up to 100 days in a Medicare-approved skilled nursing facility before the payment responsibility falls on the patient. If your treatment and services during your time at a skilled nursing facility include physical therapy sessions then it will be covered by Medicare.  

Does Medicare cover physical therapy for back pain? 

Medicare will cover physical therapy sessions for back pain so long as it is deemed medically necessary by your doctor. You will need a referral for the therapy from your doctor before Medicare will cover the sessions.  

Medicare physical therapy billing  

To get coverage for physical therapy sessions, you must meet certain requirements for billing. Your doctor must certify the plan with your physical therapists for Medicare to cover the sessions. The initial certification will last for 90 days when your ordering doctor will have to recertify that the physical therapy is medically necessary.  

An important part of Medicare physical therapy billing is the 8-minute rule. This rule serves as a guideline for physical therapists to know how many units of service to bill to Medicare. The rule states that direct treatment must be administered for at least 8 minutes before it qualifies as a billable unit for Medicare. Medicare bills 15-minute increments. The 8-minute rule acts as a clarification for how many units can be billed. For example, if you receive a 50-minute physical therapy session, Medicare will be billed for three 15-minute units. Even though this only adds up to 45 minutes, the remaining 5 minutes don’t meet the guidelines of the 8-minute rule.  

Medicare physical therapy cap 2024 

Technically there is no Medicare cap for physical therapy so long as they are medically necessary. There is no limit to how much Medicare will pay for outpatient services each year. There is a threshold for physical therapy coverage for Medicare and is set at $2,330 for 2024. Physical therapists can exceed the threshold so long as the treatment is still medically necessary.   

Medicare reimbursement for physical therapy 

Medicare covers 80% of the costs for physical therapy for the Medicare-approved amount. Once you meet your deductible for your Medicare Part B plan, you will be responsible for 20% of the cost.

Article updated on October 24, 2023