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Incontinence or bladder issues are a very common problem for senior citizens.
There are many medical conditions that cause incontinence. And, fortunately, there are many treatments available for these issues as well.
One way to treat these issues is through physical therapy of the pelvic floor.
If this is a treatment that has been recommended to you, you likely have the question “does Medicare cover pelvic floor therapy?”
In this article, we answer that question in clear, plain English. You will also find the average pelvic floor physical therapy costs if you have to pay for it out-of-pocket.
Does Medicare Cover Pelvic Floor Therapy?
The short answer is no. In most cases, Medicare will not cover the cost of pelvic floor physical therapy. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your pelvic floor physical therapy.
Original Medicare Coverage of Pelvic Floor Therapy
Original Medicare (Medicare Part A and Part B) does not provide coverage for pelvic floor physical therapy. The main reason why Original Medicare does not provide this coverage is because it is not considered medically necessary.
However, Original Medicare provides coverage for general physical therapy (PT) if it is medically necessary. Your healthcare provider must first order the operation for Original Medicare to provide coverage.
Medicare Part A Coverage of PT
Coverage for physical therapy is provided by Medicare Part A if it takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment each day you are in the hospital. After 90 days, Medicare Part A will no longer provide coverage.
However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days. But you will be charged a daily copayment.
Medicare Part B Coverage of PT
Coverage for physical therapy is provided by Medicare Part B if it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of physical therapy costs. You will pay for the remaining 20 percent.
Part C Coverage for Pelvic Floor Therapy
Like Original Medicare, Medicare Advantage plans (Medicare Part C) do not cover pelvic floor physical therapy. Medicare Advantage plans have to cover everything Original Medicare covers.
But these plans offer additional benefits as well. However, what these plans will cover and how much this coverage costs will vary from plan to plan.
How Much Does Pelvic Floor Physical Therapy Cost?
On average, pelvic floor physical therapy costs around $225 for the first consultation and $180 after that for a 45-minute session. This cost will vary depending on the provider.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover MinuteClinic Visits?