Medicare does cover physical therapy deemed necessary to treat injuries and illnesses, such as chronic conditions or fall recoveries. Additionally, Medicare covers occupational therapy, which includes therapy for daily living activities, such as bathing, dressing, and eating.
Medicare also covers speech-language pathology which evaluates and treats patients to regain and strengthen speech and language skills.
Denver Total PT is a Boulder-based physical therapy that serves patients from all across the Front Range. We are a full-service therapy clinic dedicated to healing your joint and muscle injuries to speed up your recovery. With personalized one-on-one care and expert physical therapists, we use proven techniques to provide quick pain relief.
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What Does Physical Therapy Do for You?
Physical therapy treats many different injuries and ailments and can assist in many ways. From acute to chronic injuries and illnesses, reconditioning physical therapy can teach you how to walk again after a traumatic fall or injury, address joint issues, and maintain your strength and balance.
Physical therapists often work in a team comprising of many different healthcare professionals including occupational and speech therapists.
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What Inpatient Physical Therapy Does Medicare Cover?
Medicare Part A covers inpatient stays in hospitals, skilled nursing facilities, and some home care. It also covers physical therapy at inpatient rehabilitation facilities. It might cover in-home care if you are eligible for home care. Lastly, it might cover the care you would receive at nursing homes.
All deductibles and coinsurance costs depend on the treatment location. This means that if you receive care at a hospital rather than a private practice, your costs will be different.
Does Medicare Cover Outpatient Physical Therapy?
Medicare covers outpatient therapy services including occupational therapy, physical therapy, and speech-language pathology. However, your doctor or therapist must carefully review the plan.
Medicare Part B covers outpatient physical therapy once you pay the annual Part B deductible. This deductible is for doctor’s and outpatient services, the equivalent of $226 in 2023. You will also pay 20% of the Medicare-approved amount for outpatient occupational therapy, physical therapy, and speech-language pathology.
This applies whether you receive therapy at a doctor’s office, hospital outpatient departments, nursing facilities, home, or outpatient rehab centers.
It’s important to note that Medicare no longer limits outpatient services. That cap was taken away in 2018. While the program no longer limits what it will pay yearly for medically necessary therapy, your provider must confirm the therapy’s necessity if your total costs reach a specific amount. For 2023, that amount is $2,230 for physical therapy and speech-language pathology.
What Is Medicare Advantage?
Medicare Advantage (MA) pays for inpatient physical therapy, but you will likely have to pay for coinsurance and copays. In contrast with the standard Medicare, most MA plans limit the area you can receive care from. You might not be able to receive care from the hospital or skilled nursing facilities you trust.
Will Medicare Supplement Insurance Help Cover the Cost of Physical Therapy?
Medicare supplement insurance (Medigap) helps cover out-of-pocket costs such as deductibles, copays, and coinsurance from Medicare Parts A and B. All Medigap plans cover Part A insurance and most cover the deductible. More than half of the Medigap plans out there pay the bills for coinsurance in skilled nursing facilities.
Every standardized Medigap plan except for plans K and L fully covers Part B copayments or coinsurance as well. This means there’s an excellent chance Medigap covers your outpatient physical therapy (PT) costs. The Medigap plan you choose for your health needs determines what physical therapy costs are covered.
Does Medicare Cover Telehealth Visits for Physical Therapy?
Medicare payments expanded during COVID-19 for telehealth care. These included coverage for a wide range of services, including gait treatment to orthotics and prostheses management. The American Medical Association (AMA) and many other organizations are in favor of expanding the telehealth benefits and Medicare Advantage Plans have even expanded their telehealth offerings.
How Many Physical Therapy Sessions Will Medicare Pay for?
As long as your healthcare provider deems skilled PT medically necessary, Medicare will pay for it. You can expect your provider to reassess the necessary measures periodically and there is no improvement standard that will get your claims denied. Medicare will pay for up to 25% of your physical therapy if you’re in a skilled nursing facility and they believe a group setting is best for your recovery.
What Will You Have to Pay for Out-of-Pocket?
Whether you have physical therapy at home or at a physical therapy center, Medicare will cover physical therapy and its accompanying treatments. They will do so as long as the therapist follows the guidelines set forth in your plan. This insurance coverage can be up to the entirety of your treatment but it can also be less.
If you have the original Medicare and you receive outpatient care, the insurance company pays 80% of the allowable costs after you pay the deductible. Unless you have supplemental health coverage through Medicare, you will be required to cover 20% of the costs from out-of-pocket.
Medicare Advantage Plans will likely require you to pay coinsurance and copays.
Conclusion- Does Medicare Pay for Physical Therapy?
Medicare covers physical therapy if it is necessary. Your coverage plan might also include occupational therapy and speech-language pathology. As with any insurance plan, you should check with your provider for details to ensure you feel comfortable with your decision.
At Denver Total PT, we believe our patients deserve access to the care and attention they deserve. That’s why we offer them access to resources so they feel comfortable with the services we provide.
If you struggle with an injury and believe physical therapy might be the best option for your recovery, contact us today at (303) 758-5060.