The pandemic spurred the Centers for Medicare & Medicaid Services (CMS) to expand telehealth coverage. Some of the service coverage expansion was temporary and covered specific healthcare needs, while other telehealth guidelines have become permanent.  

Does Medicare cover telehealth visits for physical therapy? 

Yes, Medicare does currently cover telehealth for some physical therapy. If your healthcare provider recommends physical therapy, Medicare Part B will cover much of the cost. You must first pay the deductible, and then you will also be responsible for paying 20 percent of the Medicare-approved amount. Medicare does not limit how much it will pay for outpatient physical therapy services within the year, but your physical therapist may recommend more visits than what Medicare has authorized. Additionally, many Medicare Advantage plans incorporate telehealth coverage as part of their basic benefits packages.  

Before the pandemic, physical therapy telehealth was not covered by Medicare. Now, patients can receive virtual services from physical therapists under their Medicare Part B coverage. Their providers do not have to be in the same geographical location to offer covered care. 

Do Medicare Advantage plans provide telehealth coverage? 

Medicare Advantage plans, also known as Medicare Part C, are private insurance plans guided by Medicare. These plans may cover some additional aspects of physical therapy not covered by Medicare Part B. However, you shouldn’t assume that their Medicare Advantage plan automatically covers fees or other services.  

When selecting a Medicare Advantage plan, it is advisable to review whether the plan you are choosing provides additional Medicare telehealth physical therapy coverage. But it can be challenging to plan for services you might not have needed when selecting a plan but might need in the future. It is essential that people review all their options if they are choosing a Medicare Advantage plan to get the coverage they need for whatever may come their way. 

Will Medigap cover my virtual physical therapy costs? 

Most of the available Medicare Supplement Insurance (Medigap) plans cover outpatient physical therapy, which currently includes telehealth for physical therapy sessions. Plans K and L, which have high deductibles, may not fully cover the associated coinsurance or copayments.  

When will Medicare telemedicine reimbursement for physical therapy end? 

As a result of the COVID-19 public health emergency (PHE), CMS greatly expanded telehealth coverage for patients. However, CMS has not permanently added physical therapy services such as prostheses and orthotics guidance and training and gait training to its Medicare Telehealth List. As it now stands, Medicare telemedicine reimbursement for physical therapy will expire on December 31, 2023.   

CMS telehealth billing guidelines 

Telemedicine takes many forms. But there are specific guidelines for how providers can receive Medicare telemedicine reimbursement for physical therapy. For example, audio-only visits may sometimes be necessary, but they can’t replace a face-to-face visit, whether virtual or in-person. Qualifying services on the Medicare Telehealth List must include an audio and video component allowing communication and interaction in real-time unless the patient has declined video access. It’s also crucial that your provider indicates that your Medicare telehealth physical therapy services are medically necessary to ensure that Medicare Part B covers them. 

What is telehealth? 

While telehealth existed before COVID-19, the pandemic accelerated the use of telehealth to allow patients to continue accessing medical services from their healthcare providers without appearing in person at the healthcare facility. Telehealth is a way for healthcare providers to: 

• Send and receive secure messages and files; 
• Speak live via video chat or over the phone to patients; 
• Use a device to remotely monitor a health condition or vital signs to track progress and make adjustments to care. 

Many people use telehealth and telemedicine interchangeably, but there are differences. Telehealth is a broader term and includes all the electronic technologies that providers use to deliver care at-a-distance, while telemedicine refers to practicing medicine via electronic technologies to provide care to patients at-a-distance. Another term that people often confuse with telehealth is e-visits. 

Telehealth vs. e-visits 

Technology plays an increasingly significant role in how people participate in healthcare. It’s easy to confuse the different terms since, in some cases, there is some overlap, and the lines of distinction have blurred. Patients may access health care via virtual visits in four main ways: 

• Telehealth, which includes real-time video and audio interaction; 
• Telephone visits, usually not covered by Original Medicare but often covered by Medicare Advantage; 
• Virtual check-ins to determine if a patient needs to have an in-office visit 
• E-visits, where the patient and healthcare provider interact online, often via chat, but not in real-time. 

Providers will bill Medicare differently depending on the virtual visit type. 

Federal policy has also expanded the platforms providers and patients can use to include popular apps like Facebook Messenger video chat, Google Hangouts, Zoom, and others. The expansion of telehealth has made healthcare more accessible for many people who previously encountered barriers to in-person services.  

Telehealth services are more extensive than many people think. People can use this method for many different types of care, such as: 

• Recurring conditions; 
• Skin conditions; 
• Lab and x-ray results; 
• Some urgent care issues; 
• Occupational and physical therapy; 

Providing physical therapy via telehealth can make this important service far more accessible to patients who cannot regularly attend in-person physical therapy. However, many people are confused about whether their Medicare plan covers their telehealth needs. Let’s look at how Medicare handles coverage for physical therapy telehealth. 

The future of Medicare physical therapy telehealth coverage 

Organizations such as the American Medical Association and the American Physical Therapy Association acknowledge that expanding telehealth coverage allows providers flexibility and makes care more accessible. Many groups and Medicare recipients are advocating to make the changes permanent and further expand telehealth coverage. For now, patients can benefit from working with Medicare plan providers to ensure they are enrolling in the plan with the best features for them.