Physical therapy is an important part of treating or managing serious conditions such as stroke and Parkinson’s disease. It helps to restore the body’s functions, relieve pain, and increase mobility. Physical therapy can also help in slowing down the further deterioration of your medical condition.
So a common question many people have is, “does Medicare cover physical therapy?” In this article, we answer that question in clear, plain English. You will also find the average costs of physical therapy and other helpful info.
Does Medicare Cover Physical Therapy?
The short answer is yes; Medicare will cover the cost of physical therapy. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your physical therapy. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for physical therapy. Coverage for physical therapy is provided by Medicare Part A if it is part of your inpatient stay/treatment or if it is medically necessary to improve your condition after your hospital stay.
Most of the time, coverage for physical therapy is provided by Medicare Part B. That is because physical therapy is usually an outpatient procedure. Medicare Part B will provide coverage for your physical therapy if it is considered medically necessary. Medicare Part B considers physical therapy as medically necessary if it will:
- Improve your condition
- Maintain your condition
- Slow down the further deterioration of your condition
Your physical therapist is required to show documentation that proves that your physical therapy is medically necessary. It must include a treatment plan that contains the following information:
- Diagnosis of medical condition
- The certain type of physical therapy that you need
- Long-term effects that you will receive from your physical therapy
- Amount of physical therapy sessions you need in a day or week
- The total amount of physical therapy sessions that you need
However, only a doctor or a physical therapist can provide the physical therapy and they must be Medicare-approved.
Once approved, Medicare Part B will cover 80 percent of the costs of your physical therapy. You will pay for the remaining 20 percent.
Part C Coverage for Physical Therapy
Medicare Advantage plans (Medicare Part C) also provide coverage for physical therapy. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part D will provide coverage for prescription medications that you may need as part of your physical therapy or recovery plan.
How Much Does Physical Therapy Cost?
Physical therapy can cost between $20 to $55 per session on average. On the other hand, home service physical therapy can average from $100 to $150 per session. Your therapist’s travel expenses are one factor that affects the cost of home service physical therapy.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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 orthopedic surgery?