Does Medicare cover physical therapy?
Usually covered
Medicare Part B covers medically necessary outpatient physical therapy, and you pay 20% of the Medicare-approved amount after the Part B deductible with no hard dollar cap.
- Covered when The therapy is medically necessary with a documented plan of care — covered even past the reporting threshold when the need is justified.
- Covered when You get PT during a covered inpatient hospital or skilled nursing stay, or through the home health benefit if you're homebound and qualify.
- Not when The therapy has become maintenance or general fitness that doesn't require the skills of a licensed therapist.
What flips the answer
- Covered when
The therapy is medically necessary with a documented plan of care — covered even past the reporting threshold when the need is justified.
- Covered when
You get PT during a covered inpatient hospital or skilled nursing stay, or through the home health benefit if you're homebound and qualify.
- Not covered when
The therapy has become maintenance or general fitness that doesn't require the skills of a licensed therapist.
Key facts
- Verdict
- Usually covered
- Applies to
- physical therapy · Medicare
- Covered when
- The therapy is medically necessary with a documented plan of care — covered even past the reporting threshold when the need is justified.
- Not covered when
- The therapy has become maintenance or general fitness that doesn't require the skills of a licensed therapist.
- Verified
- 2026-07-03 · 1 primary source
Original Medicare (Part B) covers outpatient physical therapy when it's medically necessary to treat your condition and a doctor or therapist sets up and periodically reviews a plan of care. After you meet the Part B deductible, you generally pay 20% of the Medicare-approved amount.
The old annual 'therapy cap' no longer cuts off coverage. There's still a threshold above which the provider must confirm and document that continued therapy is medically necessary, but there's no fixed dollar limit that ends your benefit.
Physical therapy is also covered in other settings under the right conditions — during a covered inpatient hospital or skilled nursing facility stay (Part A), and at home as part of the home health benefit if you're homebound and qualify.
What isn't covered is therapy that stops being medically necessary — for example, general fitness or maintenance exercise you could do on your own without a skilled therapist's involvement.
What people typically pay
Under Part B, you typically pay 20% of the Medicare-approved amount after meeting the Part B deductible. The exact amount per visit varies by the services billed, whether your provider accepts assignment, the type of facility, and your region.
Without coverage, out-of-pocket costs vary widely by setting, session length, and the treatments involved, and a full course of care over several weeks can add up substantially.
Amounts vary by provider, other insurance you may have, whether your doctor accepts assignment, and whether you have a Medigap or Medicare Advantage plan that changes the coinsurance.
How to actually get it covered
See a doctor or physical therapist and get a written evaluation and plan of care that documents your diagnosis and treatment goals.
Confirm that your doctor or other health care provider certifies you need the therapy, and check that your therapist accepts Medicare assignment.
Confirm whether you have Original Medicare or a Medicare Advantage plan — if Advantage, check network requirements and ask whether prior authorization is needed.
Attend visits and have the therapist track progress; once billing crosses the reporting threshold, ask them to attach the documentation confirming continued medical necessity.
Pay the Part B deductible if not yet met, then your 20% coinsurance — or let your Medigap plan cover it if you have one.
If a claim is denied, request the denial reason and file an appeal through the process listed on your Medicare Summary Notice.
Common questions
Does the old therapy cap still limit how many PT sessions Medicare pays for?
No. The hard annual dollar cap was repealed. There is now a reporting threshold where your therapist must add documentation confirming continued therapy is medically necessary, but as long as that need is justified, Medicare keeps paying its share with no fixed session or dollar limit.
Do I need a doctor's referral before Medicare will cover physical therapy?
Your doctor or other health care provider (such as a nurse practitioner, clinical nurse specialist, or physician assistant) must certify that you need the therapy, and a plan of care is set up and periodically reviewed. Rules on whether a therapist can begin treatment before certification can vary, so check with your provider about the requirements that apply to your visits.
What happens if Medicare decides my physical therapy is no longer medically necessary?
Coverage ends once therapy becomes maintenance or general fitness you could do without a skilled therapist. If your claim is denied, you generally have the right to appeal, and your therapist can supply documentation showing why continued skilled care is still needed. You may also be asked to acknowledge, before agreeing to pay out of pocket, that Medicare isn't expected to cover the service.
Does Medicare cover physical therapy done at home?
Yes, if you qualify for the home health benefit — meaning you're homebound and a doctor orders skilled care. PT delivered through an approved home health agency is covered under the home health benefit. Outpatient PT you travel to falls under Part B, where you pay 20% of the Medicare-approved amount after the deductible.
Is physical therapy handled differently under Medicare Advantage?
Medicare Advantage plans must cover at least the same PT as Original Medicare, but they set their own copays, networks, and rules. Many require you to use in-network therapists and may ask for approval before a course of treatment, so your out-of-pocket cost and process can differ from Part B. Check your plan's specific terms.
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