Medicare covers physical therapy, but only when a doctor orders it for a specific medical condition and you receive it in a setting Medicare recognizes.

Medicare Part B pays for physical therapy in outpatient settings — that means clinics, hospitals, and your home — after you meet your yearly deductible and pay your share of the cost. The therapy must be ordered by a doctor, nurse practitioner, or physician assistant, and it must be medically necessary to treat an injury, illness, or surgery recovery. Medicare will not pay for physical therapy you seek on your own, even if a therapist agrees to see you.

The amount Medicare pays depends on where you receive the therapy. In a clinic or hospital outpatient department, Medicare typically covers 80 percent of the cost after your deductible. In your home, the rules are different — you may owe nothing if a home health agency is involved, but the details depend on whether you also need skilled nursing or other home services.

Key Takeaways

  • Your doctor, nurse practitioner, or physician assistant must order physical therapy for Medicare to cover it; you cannot refer yourself.
  • Medicare Part B covers outpatient physical therapy in clinics, hospitals, and your home after you pay your yearly deductible.
  • Medicare typically pays 80 percent of the cost in a clinic or hospital after your deductible; you pay the remaining 20 percent.
  • Physical therapy in your home may be covered at no cost to you if a home health agency provides it as part of a skilled care plan.
  • Medicare has an annual limit on how much it will pay for physical therapy combined with occupational therapy, though Congress has suspended this limit in recent years.

How to get a physical therapy order from your doctor

Start by talking to your primary care doctor, cardiologist, orthopedic surgeon, or whichever doctor is treating your condition. Tell them you believe physical therapy would help — for example, after knee surgery, a stroke, or chronic pain. The doctor will examine you, review your medical history, and decide whether physical therapy is medically necessary.

If the doctor agrees, they will write an order (sometimes called a prescription or referral) that names the type of therapy you need and how often. This order goes to the physical therapy clinic or home health agency you choose. You do not need Medicare's permission in advance — the order itself is your authorization. However, if the therapist or clinic thinks the therapy is not medically necessary, they may contact Medicare to check coverage before you start.

Physical therapy in a clinic or hospital outpatient department

This is the most common setting. You go to a clinic or hospital outpatient center for one or more sessions per week. Medicare Part B covers the cost after you have paid your yearly Part B deductible (which varies by year). Once you have met the deductible, Medicare pays 80 percent of what it considers the reasonable charge, and you pay 20 percent.

The actual bill you receive depends on whether the clinic is in-network with Medicare. Most physical therapy clinics accept Medicare assignment, which means they agree to bill Medicare directly and accept Medicare's payment as payment in full for their services. If a clinic does not accept assignment, you may owe more out of pocket. Always ask the clinic whether they accept Medicare assignment before your first visit.

You should also ask the clinic to tell you upfront how many sessions Medicare is likely to cover for your condition. While Medicare does not require you to stop therapy after a certain number of visits, it does review whether the therapy is still medically necessary. If you have had many sessions and are not improving, Medicare may deny payment for additional visits.

Physical therapy in your home

Home physical therapy is covered when a home health agency provides it as part of a skilled care plan — usually after a hospital stay or when you are temporarily unable to leave home safely. In this case, Medicare Part A (if you are in a hospital stay) or Part B (if you are not) covers the cost, and you typically owe nothing beyond your regular Part A or Part B costs.

However, home physical therapy ordered by your doctor but delivered by an independent therapist who comes to your home is covered under Part B, the same as clinic-based therapy. You will owe your deductible and 20 percent coinsurance. The therapist must be employed by or contracted with a Medicare-approved home health agency or therapy provider for Medicare to pay.

Medicare's annual therapy cap and recent changes

For many years, Medicare set an annual limit on how much it would pay for physical therapy combined with occupational therapy — a threshold that reset each January. However, Congress has suspended this limit repeatedly, and it has not been enforced since 2020. You should check with your doctor or clinic about the current status, as rules can change.

Even without a formal cap, Medicare reviews your therapy to make sure it remains medically necessary. If you have had many sessions and your condition is not improving, your therapist may need to document your progress and explain to Medicare why continued therapy is still needed. This is not a denial, but it means your therapist will do extra paperwork to justify the next round of visits.

What Medicare does not cover for physical therapy

Medicare does not cover physical therapy for general fitness, wellness, or prevention — even if your doctor thinks exercise would be good for you. It also does not cover therapy ordered by a physical therapist alone; the order must come from a physician, nurse practitioner, or physician assistant. Some therapies that look like physical therapy, such as massage therapy or acupuncture, are not covered under the physical therapy benefit, though Medicare may cover acupuncture for chronic lower back pain under separate rules.

If you have a Medigap or Medicare Advantage plan, your coverage may be slightly different. Some Advantage plans offer additional physical therapy benefits or lower out-of-pocket costs. Check your plan documents or call your plan's customer service line to understand your specific coverage.

How to find a Medicare-approved physical therapist

You can search for physical therapists on Medicare.gov using the "Care Provider Search" tool, or you can ask your doctor for a referral to a clinic they work with. When you call a clinic, ask whether they accept Medicare assignment and whether they are in-network with your Medicare Advantage plan (if you have one). You can also ask whether they have treated your specific condition before and what their typical number of sessions is.

If you are looking for home physical therapy, ask your hospital discharge planner or your doctor to refer you to a home health agency that Medicare covers. The agency will handle the paperwork with Medicare and coordinate your care.

Frequently Asked Questions

Do I need a referral from my primary care doctor, or can any doctor order physical therapy?

Any doctor, nurse practitioner, or physician assistant treating you can order physical therapy — it does not have to be your primary care doctor. However, the person ordering it must be licensed to do so. A physical therapist cannot order their own services; the order must come from a physician or advanced practice provider.

What if my doctor says I need physical therapy but Medicare denies it?

If Medicare denies a claim, the clinic or your doctor's office should send you a notice explaining why. You have the right to appeal. The first step is usually to ask your therapist or clinic to submit additional documentation showing why the therapy is medically necessary. If that does not work, you can file a formal appeal with Medicare, and you have the right to request a hearing.

Will I owe anything out of pocket for physical therapy?

Yes, unless you have met your Part B deductible and have supplemental coverage. You will owe your yearly deductible (if you have not met it) and then 20 percent coinsurance for each visit. If you have a Medigap plan, it may cover some or all of your coinsurance. If you have a Medicare Advantage plan, your costs depend on your specific plan.

Can I choose any physical therapist, or do I have to use one Medicare approves?

You can choose any licensed physical therapist, but Medicare will only pay if the therapist is employed by or contracted with a Medicare-approved provider — usually a clinic, hospital, or home health agency. If you see a therapist who is not part of a Medicare-approved setting, Medicare will not pay, and you will owe the full cost.

How long does Medicare cover physical therapy?

There is no set time limit. Medicare covers physical therapy as long as it is medically necessary and you are making progress toward your treatment goals. Your therapist will document your progress at regular intervals. If you stop improving, Medicare may question whether continued therapy is still necessary, and your therapist may need to explain why it should continue.