What physical therapy does Medicare cover?

Physical therapy is a type of medical treatment that can help patients recover from injuries, manage chronic pain, and improve their overall physical functioning. For many older adults in the United States, Medicare provides coverage for physical therapy services. However, it is important to understand what types of physical therapy are covered by Medicare and what requirements must be met to qualify for coverage.

Medicare is a federal health insurance program that provides coverage for individuals aged 65 or older, as well as younger individuals with certain disabilities or chronic conditions. Medicare coverage for physical therapy is divided into two parts: Part B and Part A.

Part B covers outpatient physical therapy services, which are services provided in a healthcare setting such as a doctor’s office, clinic, or outpatient rehabilitation facility. These services may include evaluation and assessment, exercise programs, manual therapy, and other treatments designed to improve a patient’s physical functioning. In order to qualify for coverage, the patient must have a medical condition or injury that requires physical therapy, and the therapy must be provided by a qualified healthcare professional such as a physical therapist.

Under Part B, Medicare covers up to 80% of the cost of physical therapy services, and the patient is responsible for paying the remaining 20% as well as any deductibles or copayments required by their plan. There may also be limits on the number of therapy sessions covered by Medicare in a given year, so it is important to check with your provider to ensure that your treatment will be covered.

In addition to Part B coverage, Medicare Part A may also provide coverage for physical therapy services in certain situations. Part A covers inpatient hospital stays, and may cover physical therapy services provided during a hospital stay if they are deemed medically necessary by a doctor or other healthcare provider. In these cases, the cost of physical therapy is typically covered by Medicare, although the patient may still be responsible for paying any deductibles or coinsurance required by their plan.

It is important to note that not all physical therapy services are covered by Medicare. For example, Medicare typically does not cover physical therapy services that are primarily designed to promote general fitness or wellness, or that are provided for non-medical reasons such as weight loss or stress relief. Additionally, some types of physical therapy may not be covered if they are deemed experimental or investigational by Medicare.

In conclusion, Medicare provides coverage for certain types of physical therapy services under both Part A and Part B. To qualify for coverage, patients must have a medical condition or injury that requires physical therapy, and the therapy must be provided by a qualified healthcare professional. While Medicare covers a significant portion of the cost of physical therapy, patients may still be responsible for paying deductibles, copayments, or coinsurance, and there may be limits on the number of therapy sessions covered in a given year. If you are considering physical therapy and are covered by Medicare, be sure to speak with your healthcare provider to determine what services are covered and what your out-of-pocket costs may be.