If you face challenges regarding flexibility, mobility, strength and joint pain, physical therapy is likely a part of your life. Physical therapy is one of the most common ways to treat ailments that affect joints and muscles, and this non-invasive approach is typically considered before moving onto more invasive methods of treatment like surgery. Prescription medications may be used in conjunction with physical therapy, but the core of physical therapy treatment involves physical exercises that are designed to strengthen the body and rehabilitate injuries.

What Are My Medicare Physical Therapy Benefits?

What does Medicare pay for when it comes to physical therapy? The answer depends on how physical therapy is administered and where.

In the majority of cases, physical therapy is covered by Medicare through Part B. To enjoy the Medicare benefits of Part B, you will need to meet your deductible, and a copay or coinsurance may apply. For most people, Medicare will cover 80% of Part B costs, leaving the remaining 20% to be covered by you or your Medigap policy if you have one. This only applies after you have met your plan’s deductible.

Physical Therapy Benefits Under Medicare Part B

Part B is the outpatient portion of Original Medicare, and it covers visits to doctors and specialists. Since most physical therapy takes place during outpatient visits in a clinical setting, Medicare benefits under Part B apply to care. In order to be considered for coverage by Medicare Part B, your physical therapist will need to be a Medicare-participating healthcare professional. Additionally, not all treatment that is deemed as physical therapy is covered.

For example, some healthcare specialists provide massage therapy as a form of physical therapy. While massages may or may not have a therapeutic effect on physical rehabilitation after an injury or illness, Original Medicare does not cover massage therapy. Therefore, you are encouraged to speak with your plan provider prior to seeking out physical therapy services to ensure that your specific treatment is covered.

Physical Therapy Benefits Under Medicare Part A

Inpatient physical therapy takes place while admitted to a hospital or skilled nursing facility. Medicare benefits offered through Part A can be utilized for up to 60 days per benefit period at 100% cost coverage. If you require further inpatient care, you can receive an additional 30 days of coverage at a discounted rate. Beyond 90 days, you will need to use lifetime reserve days until the next benefit period begins.

As a result, your coverage for physical therapy services while admitted to a Medicare-participating hospital or skilled nursing facility will be covered according to the length of time you have spent in inpatient care. If a physical therapist is brought in from outside of the facility’s staff to administer care, Medicare benefits may be offered through Part B for these services specifically.

What Does Medicare Pay for When Receiving At-Home Physical Therapy?

If you are homebound and require physical therapy, Medicare benefits may cover home health services that include physical therapy. These will be covered by Medicare Part B in most cases, but some services may be billed through Medicare Part A if staff from a Medicare-participating hospital visit your home to provide care.