Medicare covers up to 60 physical therapy visits per year, but the actual number you receive depends on your specific plan and whether your therapist accepts Medicare

Medicare Part B pays for physical therapy when a doctor orders it for a medical condition — not for general fitness or wellness. The yearly limit is 60 visits combined across all settings: outpatient clinics, your home, or hospital outpatient departments. However, this is not a may provide that you will receive all 60. Your therapist must document that each visit is medically necessary, and Medicare can deny payment if it determines the treatment is no longer helping you improve.

The 60-visit limit resets on January 1 each year. If you have a supplemental insurance plan (Medigap) or a Medicare Advantage plan, your coverage may differ — some plans impose their own lower limits, while others may cover additional visits under certain conditions. You should check your specific plan documents or call the plan directly to learn what your coverage actually includes.

Key Takeaways

  • Medicare Part B covers up to 60 physical therapy visits per calendar year when ordered by a doctor for a medical condition.
  • Your therapist must show that each visit is medically necessary and that you are making progress, or Medicare may stop paying.
  • Medicare Advantage and Medigap plans may have different limits, so you need to check your own plan's rules.
  • You typically pay 20 percent of the Medicare-approved amount after you meet your Part B deductible.
  • If your therapist does not accept Medicare, you may pay the full cost upfront and request a refund, though Medicare will not reimburse you.

How the 60-visit limit works in practice

The 60 visits are a yearly total, not a monthly allowance. If you use 30 visits in the first six months of the year, you have 30 remaining for the rest of that calendar year. Once January 1 arrives, your count resets to 60. This means the timing of when you start therapy can affect how many sessions you have available in that year.

Medicare does not require your doctor to request all 60 visits upfront. Instead, your therapist submits claims to Medicare as you attend sessions. If Medicare determines that you have stopped improving or that continued therapy is not medically necessary, it may deny payment for future visits even if you have not reached 60. This decision is made on a case-by-case basis and can happen at any point during the year.

Some people reach their 60-visit limit before the year ends. If this happens, you can still attend physical therapy, but you will pay the full cost out of pocket unless your supplemental insurance covers additional visits. A few Medicare Advantage plans do cover therapy beyond 60 visits, but this varies widely by plan and by year.

What you pay for each session

After you meet your Part B deductible (which is $240 in 2024, though this amount changes yearly), you pay 20 percent of the Medicare-approved amount for each physical therapy visit. The remaining 80 percent is covered by Medicare. The actual dollar amount depends on where you receive therapy and what services are provided during each session.

If your therapist does not accept Medicare assignment, you may face higher costs. Some therapists who do not accept Medicare will ask you to pay the full amount at the time of service. You can then submit the claim to Medicare yourself, but Medicare will only reimburse you based on its approved amount — not the full amount the therapist charged. This means you could pay more out of pocket than if you saw a therapist who accepts Medicare.

If you have a Medigap plan, it typically covers your 20 percent coinsurance after Medicare pays its share. If you have a Medicare Advantage plan, your out-of-pocket costs depend on that specific plan's structure — some use copays instead of coinsurance, and amounts vary.

When your doctor must order physical therapy

Medicare requires that a licensed physician, nurse practitioner, or physician assistant order your physical therapy. The order must document a specific medical condition that requires treatment — such as recovery from surgery, a stroke, a broken bone, or a chronic condition like arthritis. The therapist uses this order to justify why the therapy is medically necessary.

Your doctor does not need to specify exactly how many visits you will need. However, the therapist must regularly reassess your progress and document that you are improving. If you reach a plateau where your condition is not changing, Medicare may determine that continued therapy is not medically necessary and deny further claims.

Medicare Advantage and supplemental plan differences

If you are enrolled in a Medicare Advantage plan (Part C), your physical therapy coverage is set by that specific plan, not by Medicare itself. Some Advantage plans cover the same 60 visits per year as Original Medicare, while others may cover fewer visits or impose different rules about which therapists you can see. A small number of plans cover more than 60 visits, but this is less common.

Medigap plans do not change your visit limit — they only help pay your coinsurance and deductible. If you have Original Medicare plus a Medigap plan, you still have the 60-visit yearly limit, but Medigap covers your 20 percent cost-sharing.

You should contact your plan directly to learn your exact coverage. The plan's customer service number is on your insurance card, and they can tell you whether there are any additional limits, prior authorization requirements, or preferred therapist networks you need to know about.

What happens if you need more than 60 visits

If your therapist believes you need more than 60 visits in a year, Medicare has a process called manual review or exceptions process. Your therapist can submit detailed documentation showing why continued therapy is medically necessary and why you are still making progress. Medicare will review this information and may approve additional visits beyond the standard 60.

This process is not automatic, and approval is not may provide. It typically takes several weeks for Medicare to make a decision. During this time, you may continue attending therapy, but payment may be delayed or denied if Medicare does not approve the exception. Your therapist should inform you of this risk before you continue sessions beyond 60.

If Medicare denies the exception request, you can appeal the decision. Your therapist or you can file an appeal, and you have the right to request a hearing before an administrative law judge. However, appeals can take months, and you will likely need to pay out of pocket during the appeal process.

How to check your remaining visits for the year

You can view your physical therapy visit count through your Medicare account on Medicare.gov. Log in to "My Medicare" and look at your claims history. This shows how many visits have been billed to Medicare and how many you have remaining for the year.

Your physical therapy clinic can also tell you how many visits you have used. Ask your therapist or the front desk staff to check your remaining balance before each session. This helps you plan ahead if you are approaching your 60-visit limit.

If you have a Medicare Advantage plan, log into your plan's website or call the customer service number on your card to check your visit balance. Each plan tracks this information differently, so the process may vary.

Frequently Asked Questions

Can I use physical therapy visits from one year into the next year?

No. Your 60-visit limit resets on January 1 each year. Any unused visits expire at the end of December and do not carry over. If you have 10 visits remaining on December 31, they are lost, and you start fresh with 60 visits on January 1.

Does Medicare cover physical therapy at home?

Yes. Home health physical therapy counts toward your 60-visit yearly limit. The same rules explore — your doctor must order it, and Medicare must determine it is medically necessary. You typically pay 20 percent coinsurance after your deductible, just as you would for outpatient therapy.

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

You have the right to appeal Medicare's denial. Your therapist can submit additional documentation, or you can file an appeal yourself. You have 120 days from the date of the denial notice to request an appeal. During the appeal, you can continue therapy at your own cost, though you may be reimbursed if the appeal is approved.

Do I need prior authorization before starting physical therapy?

Original Medicare does not require prior authorization for physical therapy — your therapist can bill Medicare directly once your doctor has ordered treatment. However, if you have a Medicare Advantage plan, that plan may require prior authorization. Contact your plan to ask before your first appointment.

What if I switch from Original Medicare to a Medicare Advantage plan mid-year?

Your visit count does not transfer between plans. If you used 30 visits under Original Medicare and then switch to a Medicare Advantage plan, your new plan will have its own visit limit starting on the date your coverage changes. The visits you used under Original Medicare do not count against your new plan's limit.