Medicare covers in-home physical therapy, but only when a doctor orders it and you meet specific conditions — mainly that you are homebound or cannot safely travel to a clinic.
Medicare Part B pays for physical therapy in your home through two routes: Medicare-approved home health agencies or independent physical therapists who accept Medicare assignment. The therapy must be medically necessary, ordered by your doctor, and tied to a condition Medicare recognizes — a stroke, hip fracture, arthritis, or post-surgical recovery, for example.
The key difference from clinic-based therapy is the homebound requirement. You do not have to be bedridden, but you must have a medical reason that makes leaving home difficult or unsafe — pain that worsens with movement, balance problems, or a recent surgery that limits weight-bearing, for instance. Your doctor documents this in the referral.
Key Takeaways
- Medicare Part B covers in-home physical therapy when ordered by your doctor and delivered by a Medicare-approved home health agency or an independent therapist who accepts Medicare assignment.
- You must be homebound — meaning leaving home is medically contraindicated or requires supportive information — for Medicare to cover the service.
- You typically pay 20 percent of the Medicare-approved amount after you meet your Part B deductible, unless you have a Medigap or Medicare Advantage plan that covers the remainder.
- Home health agencies bill Medicare directly and coordinate all care; independent therapists require you to handle billing and may charge more if they do not accept assignment.
- Your doctor must order the therapy and recertify the need every 60 days; Medicare reviews the plan to may support progress is being made.
How to Start In-Home Physical Therapy Through Medicare
The process begins with your doctor. Tell your primary care physician or specialist that you need physical therapy at home and why — pain with walking, weakness after surgery, balance problems. Your doctor writes an order that includes the diagnosis, the type of therapy needed, and how often (usually two to three times per week). The order also documents why you cannot go to an outpatient clinic.
Once you have the order, you have two paths. The first is to contact a Medicare-certified home health agency directly. These agencies employ physical therapists and handle all the paperwork with Medicare. You can find them through your doctor's office, your hospital's discharge planner, or by calling your local Area Agency on Aging. The agency will verify your Medicare coverage and explain what you will owe out of pocket.
The second path is to hire an independent physical therapist who accepts Medicare assignment. You will need to give them your Medicare card and the doctor's order. They submit the claim to Medicare themselves. If the therapist does not accept assignment, you may owe more, because they can charge above the Medicare-approved amount.
What You Pay Out of Pocket
Your cost depends on your Medicare plan. If you have Original Medicare (Part A and Part B), you pay 20 percent of the Medicare-approved amount for each therapy visit, after you have met your Part B deductible for the year. The deductible is set annually by Medicare and changes each year. The 20 percent coinsurance applies to each visit for as long as therapy continues.
If you have a Medigap policy (supplemental insurance), it usually covers the 20 percent coinsurance, so your out-of-pocket cost may be zero or a small copay. If you have a Medicare Advantage plan, your costs vary by plan — some charge a copay per visit, others charge coinsurance, and some cover in-home therapy with no cost-sharing. Check your plan documents or call the plan's member services line to confirm.
Home health agencies are required to tell you in writing what Medicare will cover and what you will owe before therapy starts. Ask for this estimate in advance so there are no surprises.
Medicare's Rules on Duration and Progress
Medicare does not set a fixed number of therapy visits you can receive. Instead, your doctor orders a plan of care — typically for 60 days — and the therapist must show that you are making progress toward a goal: regaining the ability to walk, reducing pain, improving balance, or returning to self-care tasks. Every 60 days, your doctor reviews the plan and recertifies that therapy is still medically necessary.
If you are not making progress, Medicare may deny payment for further visits. The therapist is responsible for documenting your improvements in writing and submitting that record to Medicare. You should ask your therapist at each visit what progress they are seeing and what the goal is for the next phase.
Therapy can continue beyond 60 days if progress is being made and your doctor recertifies the need. There is no hard cap on the number of visits, but Medicare audits these cases and may request records if the duration seems unusually long.
In-Home Therapy Through a Home Health Agency vs. an Independent Therapist
A Medicare-certified home health agency is often the simpler route. The agency coordinates all your care — physical therapy, nursing, occupational therapy, and social work if needed. They bill Medicare directly, handle all paperwork, and you typically owe only your coinsurance. The agency also manages the schedule and can adjust it if you need to reschedule.
An independent physical therapist gives you more control over who treats you and may offer more flexible scheduling. However, you are responsible for providing your insurance information and the doctor's order. If the therapist does not accept Medicare assignment, you may owe more than 20 percent. You also have to manage the billing yourself if there are questions.
Many people start with a home health agency after a hospital stay because the hospital discharge planner arranges it. If you want to switch to an independent therapist later, you can — just make sure they accept Medicare and have a current doctor's order.
Conditions Medicare Typically Covers for In-Home Therapy
Medicare covers in-home physical therapy for a wide range of conditions, as long as the therapy is medically necessary and ordered by a doctor. Common reasons include recovery from hip, knee, or shoulder surgery; stroke or other neurological events; heart attack or cardiac surgery; arthritis flare-ups that limit mobility; fractures; and post-hospitalization weakness.
Medicare also covers therapy for chronic conditions if there is a specific, recent change — for example, a fall that caused new pain or loss of function, or a medication change that affected balance. The key is that the therapy must address a medical problem and have a realistic goal, not be for general fitness or wellness.
If you are unsure whether your condition qualifies, ask your doctor. Your doctor knows what Medicare covers and can write the order accordingly. If Medicare denies the claim, you have the right to appeal — your therapist or home health agency can help you understand why and what to do next.
What Happens If Medicare Denies Your Claim
If Medicare denies payment for in-home physical therapy, you will receive a notice called a Medicare Summary Notice (if you have Original Medicare) or an Explanation of Benefits (if you have Medicare Advantage). The notice explains the reason — for example, "not medically necessary," "patient not homebound," or "no progress shown."
You have the right to appeal. The first step is to contact your therapist or home health agency and ask them to review the denial. Often they can resubmit with additional documentation — notes from your doctor about why you are homebound, or therapy records showing progress. If that does not work, you can file a formal appeal with Medicare. The process takes time, but many denials are overturned on appeal, especially if the documentation was incomplete the first time.
If you cannot afford to pay out of pocket while the appeal is pending, ask your therapist whether they will continue treating you. Some will; others will not. This is worth discussing upfront.
Frequently Asked Questions
Do I have to be bedridden for Medicare to cover in-home physical therapy?
No. You must be homebound, meaning leaving home is medically difficult or unsafe, but you can be mobile within your home. Examples include someone who cannot walk more than a few steps without severe pain, or someone whose balance is so poor that leaving home without help is a fall risk. Your doctor documents the reason in the referral.
Can I choose my own physical therapist, or does Medicare assign one?
You can choose an independent therapist if they accept Medicare assignment. If you use a home health agency, the agency assigns a therapist, but you can request a different one if there is a personality mismatch or scheduling conflict. Always confirm the therapist or agency is Medicare-certified before starting.
How long does it take Medicare to approve in-home physical therapy?
Once your doctor sends the order to the home health agency or therapist, approval usually takes a few days to a week. The agency or therapist verifies your Medicare coverage and homebound status, then schedules your first visit. If there are questions about medical necessity, it may take longer.
Will my Medicare Advantage plan cover in-home physical therapy the same way Original Medicare does?
No. Medicare Advantage plans set their own rules for coverage, copays, and coinsurance. Some cover in-home therapy with no cost-sharing; others charge a copay per visit. Check your plan documents or call member services to learn what your plan covers before you start therapy.
What if I improve and no longer need therapy — do I have to keep going?
No. You and your therapist can stop at any time. If you have reached your goal — walking without pain, regaining balance, or returning to self-care — your therapist will discharge you from the plan of care. Medicare only pays for therapy that is medically necessary, so once you have improved, there is no reason to continue.