Medicare will pay for physical therapy that a doctor considers medically necessary to treat an injury or illness — for example, to manage a chronic condition like Parkinson’s disease or aid recovery from a fall, stroke or surgery.
Medicare Part A, which includes hospital insurance, or Part B, which covers outpatient treatment, might cover this service depending on the circumstances and the setting. The same holds true for occupational and speech therapy.
Medicare Part A pays some or all of the cost of physical therapy you receive at an inpatient rehabilitation facility.
It might also cover such services at a skilled nursing facility or at your home after a hospitalization lasting at least three days. Whether you incur out-of-pocket costs such as deductibles and coinsurance, and how much they are, will depend on the setting for the treatment and how long it lasts.
Medicare Part B can pay for outpatient physical therapy you receive:
Unlike with Part A, prior hospitalization is not a prerequisite for Part B to cover physical therapy.
Medicare used to set an annual maximum for what it would pay for outpatient therapeutic services, but the cap was eliminated in 2018. This government health insurance program no longer limits what it will pay in a given year for a beneficiary to receive medically necessary therapeutic services.
However, keep in mind that treatment recommended by a physical therapy provider but not ordered by a doctor is not covered. In this situation, the therapist is required to give you a written notice, called an Advance Beneficiary Notice of Noncoverage or ABN, that Medicare may not pay for the service.
If you choose to proceed with the therapy, you are agreeing to pay in full.
If you have questions about coverage and costs for therapeutic services, call 1-800-MEDICARE (800-633-4227)
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