Does Medicare Cover Physical Therapy in 2022?
Updated: Aug 1, 2022
Physical Therapy can be instrumental in helping people get back to living full lives free of pain and discomfort. It's an important part of the treatment when recovering after accidents, traumas, or treating various health conditions and illnesses.
Depending on your individual case, it can get expensive to pay for physical therapy out of pocket; that's why many people ask us - does Medicare cover physical therapy.
In this article, we investigate the topic and look into different Medicare plans, cases when Medicare coverage applies, how many sessions it covers, and everything else you should know about Medicare and physical therapy.
Does Medicare Cover Physical Therapy in 2022?
It is normal that the first question people prescribed physical therapy have is, "does Medicare cover physical therapy?". The short answer is yes if the treatment is recommended by your primary physician, who deems it medically necessary for your condition, treatment or recovery.
Medicare Part A will cover your inpatient physical therapy if you need PT during or after hospitalization (in a skilled nursing facility after discharge if you are in the hospital for at least three days). Medicare Part B covers the costs of outpatient or at-home physical therapy.
You may need to cover part of the cost, and deductibles and coinsurance may apply if you have not stayed at the hospital.
The second question is, how many physical therapy sessions does Medicare cover? The good news is that Medicare no longer enforces these physical therapy limits, and today you can have as much physical therapy as is medically necessary. Original Medicare covers outpatient therapy at 80% of the approved amount. This means that when you receive services from a participating provider, you pay a 20% coinsurance after meeting your Part B deductible, which is $233 in 2022.
Keep in mind, though, that the combined amount that Medicare pays for physical and speech therapy is up to $3,000 before reviewing a patient's case to ensure that it is medically necessary. After that, you can still have the coverage for your physical therapy services, but they must be billed with separate codes to prove medical necessity.
Physical Therapy Benefits
Physical therapy is essential for treating or recovering various conditions, illnesses, and traumas.
It helps relieve pain, increase mobility and restore function. It's immensely beneficial for conditions like stroke, cardiovascular illnesses, Parkinson's diseases, and many others. It can also help maintain your overall fitness, increase your range of motion and improve your quality of life.
What Does Physical Therapy Help?
Reduce or eliminate pain
Avoid and recover from surgery
Improve mobility and range of motion
Recover from or prevent a sports injury.
Recover from stroke
Recover from accidents and traumas
Improve balance and prevent falls.
Manage diabetes and vascular conditions.
Prevent illness or condition from getting worse.
Manage age-related issues
Manage heart and lung disease.
Manage Women's Health
Physical therapy modalities include massage, mobilization, heat, cold, air, light, water, electricity, and others.
It depends on the individual's needs and progress and how many sessions you will need, but on average, 6 to 12 visits is enough to cover most cases and diagnoses. You will most likely have three visits per week initially, but in time and depending on your progress, this number may be reduced.
You can expect a session to last between 45 and 75 minutes.
When Does Medicare Pay for Physical Therapy?
So does Medicare pay for physical therapy? Yes, you can receive services for physical therapy when your physician or PT deems it medically necessary. Your eligibility for coverage for outpatient physical therapy services varies, and your PT will need to prove the necessity of the treatment.
They will need to provide this documentation:
Your detailed diagnosis
The type of PT you'll be receiving
The long-term goals of your treatment
The amount of PT sessions needed
If you cannot travel to your physician's office, you may receive Medicare cover physical therapy at your home in full. For that, you need to be under a doctor's care and have your doctor certify that you are unable to travel and need PT to improve or maintain your current physical condition.
Keep in mind that Medicare also pays a portion of the cost for medical equipment used during treatment.
Medicare Coverage for Physical Therapy
PT service is considered medically necessary when it's used to improve your current condition and health, maintain your current condition and prevent or slow down further deterioration.
In order for Medicare to cover these services, they need to be provided by a qualified professional, which means, e.g., general fitness services will not be covered under Medicare.
Keep in mind that your physical therapist must give written notice before providing services that Medicare does not cover, so you can choose whether you want these services.
There are different parts of Medicare you should be aware of to make the best decision for your health and wellbeing. We examine these parts and provide the most important details below.
Medicare Part A
Medicare Part A is hospital insurance and covers physical therapy, and costs related to these services in inpatient stays at facilities like:
Mental health facilities
Limited stays at skilled nursing facilities
Limited home healthcare
Remember that to be covered by Part A, you need your primary physician's confirmation that it is considered medically necessary to improve your condition during and after hospitalization.
Medicare Part B
Medicare Part B covers medically necessary outpatient services and sometimes certain preventive services. Part B covers medically necessary physical therapy sessions that include the diagnosis and treatment of conditions or illnesses.
This type of physical therapy care can be provided at these facilities:
Privat physical therapy practices
Hospital outpatient departments
Outpatient rehabilitation centers
Skilled nursing facilities
At patients homes
Medicare Part C
Medicare Part C is also known as Medicare Advantage. It is offered by private companies that Medicare has approved.
These plans include the coverage provided by parts A and B and medically necessary PT.
What's included in a Part C plan varies by plan, company, and location, so understand all the details relevant to you; you should check for information regarding any plan-specific rules for therapy services. Part C plans are sold by private insurance companies.
Medigap is also known as Medicare supplement insurance. It is sold by private companies and can cover some costs that aren't covered by Medicare Parts A and B.
Medical care outside the US
How to Choose the Best Medicare Plan for Physical Therapy Coverage
Many patients wonder how to choose the best plan for their physical therapy needs. This depends on certain factors.
If you know that you will need PT in the coming year, Medicare parts A and B, also known as the "original Medicare," will cover medically necessary PT.
However, in certain situations, people are concerned about additional costs that aren't covered by these parts, and then adding a Medigap plan can help pay for things like copays which can add up significantly during the treatment period.
If you know or anticipate that you may need fitness programs in addition to your physical therapy treatment, you may consider the Medicare Part C plan that includes Medicare Parts A and B and often additional services that are not covered by these parts.
FAQs About Medicare Physical Therapy Coverage
Let's take a look at the most frequently asked questions about Medicare Physical Therapy coverage, including how many physical therapy sessions does Medicare cover and whether you can be denied coverage.
How Many Physical Therapy Sessions Does Medicare Cover?
Original Medicare covers outpatient physical therapy at 80% of the approved amount.
This means that you need to pay a 20% coinsurance after you meet your Part B deductible, which is $233 in 2022.
Can Medicare Deny Physical Therapy?
Yes, if you can't provide documentation by a physician or physical therapist that the physical therapy services are medically necessary, Medicare can deny coverage.
Remember that your claim will only be approved if a licensed physician authorizes the services, so make sure you get a referral before going for treatments so you don't end up with a bill.
What is the Medicare Physical Therapy Cap for 2022?
The physical therapy cap for 2022 is $2,150 for combined physical therapy and speech-language pathology services.
It applies to all services in outpatient settings, including private practices, critical access hospitals, and skilled nursing facilities under Medicare Part B. It's important to note that the therapists can exceed these caps for medically necessary services, but a medical review process will be required if the services total more than $3,000.
Does Medicare Need a Referral to Pay for Physical Therapy?
Yes, however, it's important to note you can have your first session without a physician's referral.
However, once and if during the evaluation and assessment, your physical therapist deems that the treatment is medically necessary, you need to get a referral from your physician, so make sure to schedule your appointment.
Opposite to Medicaid, which is more indicated to individuals, especially families with children, Medicare is the ideal insurance for seniors.
Since seniors over 65 need physical therapy to improve their quality of life, it is important to know all the details about it. Make sure to contact Medicare help center to know if your plan covers the physical therapy services you need.
Remember that if you contact Miracle Rehab, you can ask about whether Medicare covers the services you need and we will be completely open to answer your questions.