Medicare covers physical therapy, but only when a doctor orders it for a medical reason and you receive it in a Medicare-approved setting.

Medicare Part B pays for physical therapy if a licensed therapist provides it in a hospital outpatient department, a skilled nursing facility, a home health agency, or an outpatient rehabilitation facility. The therapy must be medically necessary — meaning your doctor has documented that you need it to recover function or manage a condition — and you must have a doctor's written order before treatment begins.

You pay 20 percent of the approved amount after you meet your Part B deductible. There is no limit on the number of visits Medicare will cover in a calendar year, but Medicare requires periodic review to confirm the therapy is still medically necessary and producing progress toward your goals.

Key Takeaways

  • Physical therapy is covered by Medicare Part B when ordered by a doctor and delivered in an approved setting such as a hospital outpatient clinic, skilled nursing facility, or your home.
  • You pay 20 percent of the Medicare-approved amount after meeting your Part B deductible, and there is no annual visit limit.
  • Medicare requires your therapist to document progress every 10 visits or every 30 days, whichever comes first, to show the therapy is working.
  • Private practice physical therapy clinics are covered only if they are enrolled as Medicare providers and meet Medicare's facility standards.
  • If your doctor orders therapy but Medicare denies it, you have the right to appeal the decision with your doctor's supporting documentation.

Where You Can Receive Covered Physical Therapy

Medicare covers physical therapy in five main settings. Hospital outpatient departments are departments within a hospital where you receive therapy without being admitted as an overnight patient. Skilled nursing facilities are nursing homes certified by Medicare; you must have been hospitalized for at least three days before Medicare will cover skilled nursing care, including physical therapy. Home health agencies can send a physical therapist to your home if you are homebound or have difficulty leaving home, and a doctor must order home health services. Outpatient rehabilitation facilities are freestanding clinics that specialize in rehabilitation and are enrolled as Medicare providers. Comprehensive outpatient rehabilitation facilities (CORFs) are specialized centers that provide intensive rehabilitation services.

Private practice physical therapy clinics are covered only if the clinic is enrolled as a Medicare provider and meets Medicare's standards for outpatient rehabilitation facilities. Before you start therapy at a private clinic, ask the front desk whether they accept Medicare and whether they are enrolled as a Medicare provider. Not all private clinics are enrolled, and if yours is not, Medicare will not cover your visits.

What Your Doctor Must Do Before Therapy Starts

Your doctor must write an order for physical therapy that describes the medical reason you need it. The order should include your diagnosis, the specific areas of your body that need treatment, and the type of therapy recommended. Common reasons Medicare covers physical therapy include recovery after surgery, stroke, joint replacement, fracture, or other injury; management of chronic conditions like arthritis or Parkinson's disease; and restoration of function after hospitalization.

You do not need a referral from your primary care doctor if you see a physical therapist directly — many states allow physical therapists to evaluate and treat patients without a physician referral — but Medicare itself requires a doctor's order before it will pay. If you go to a physical therapist without a doctor's order, you will be responsible for the full cost of treatment. Always confirm with your therapist that they have received the doctor's order before your first visit.

How Much You Pay Out of Pocket

You pay 20 percent of the Medicare-approved amount for each physical therapy visit after you have met your Part B deductible for the year. The Part B deductible is the same amount every year and changes annually; you can find the current year's deductible on Medicare.gov or by calling 1-800-MEDICARE. Once you meet the deductible, you pay 20 percent of each approved visit for the rest of the calendar year.

The amount you pay depends on the Medicare-approved rate in your area, not on what the clinic charges. If a clinic charges more than Medicare approves, you are not responsible for the difference — the clinic must write off the overage. Ask your physical therapy clinic for an estimate of your out-of-pocket cost based on the Medicare-approved rate, not their full charge.

Medicare's Progress Review Requirements

Medicare requires your physical therapist to document your progress every 10 visits or every 30 calendar days, whichever comes first. The therapist must show that you are making measurable progress toward your therapy goals — for example, increased range of motion, improved strength, reduced pain, or restored ability to perform daily activities. If you are not making progress, your therapist must modify the treatment plan or discuss with your doctor whether therapy should continue.

If Medicare reviews your case and determines that therapy is no longer medically necessary or that you have reached your goals, Medicare may stop covering additional visits. Your therapist will notify you if this happens, and you have the right to appeal the decision. Your doctor can also request that therapy continue if they believe it remains necessary.

When Medicare Does Not Cover Physical Therapy

Medicare does not cover physical therapy ordered by a non-physician provider such as a nurse practitioner or physician assistant, even if they work in a hospital or clinic. The order must come from a doctor (MD or DO). Medicare also does not cover therapy for maintenance or prevention — only for restoration of function or management of an acute or chronic condition. If you are receiving therapy to maintain your current level of function after you have reached your therapy goals, Medicare will not pay.

Medicare does not cover therapy in settings that are not Medicare-approved, such as a private gym, a wellness center, or a clinic that is not enrolled as a Medicare provider. Therapy ordered by a doctor but delivered in a non-approved setting is your responsibility to pay for in full.

What to Do If Medicare Denies Your Therapy

If Medicare denies coverage for physical therapy your doctor ordered, you will receive a notice called an Explanation of Benefits (EOB) or a Medicare Summary Notice (MSN) that explains the reason for the denial. Common reasons include: the doctor's order did not meet Medicare's medical necessity standard, the therapy was not ordered by a physician, the setting was not Medicare-approved, or Medicare determined you were not making progress.

You have the right to appeal any denial. Ask your doctor to review the denial reason and provide additional documentation if needed — for example, test results, imaging, or notes explaining why therapy is still medically necessary. You can submit the appeal yourself or ask your physical therapist to help. Include your doctor's supporting statement with your appeal. You have 120 days from the date on the denial notice to file an appeal.

Frequently Asked Questions

Do I need a referral from my primary care doctor to see a physical therapist?

State laws vary. Many states allow you to see a physical therapist without a referral. However, Medicare requires a doctor's written order before it will pay for therapy, regardless of state law. If you want Medicare to cover your visits, you must have a doctor's order on file before treatment starts.

How many physical therapy visits does Medicare cover per year?

Medicare does not set an annual limit on the number of visits. Instead, Medicare requires your therapist to document progress every 10 visits or 30 days and to show that therapy is medically necessary and producing results. If you are making progress, you can continue receiving covered visits.

Will Medicare cover physical therapy at my home if I am not homebound?

Home health physical therapy is covered only if you are homebound or have a medical reason that makes it difficult or unsafe to leave home. If you can travel to a clinic, Medicare expects you to receive therapy in an outpatient setting. Your doctor and the home health agency will determine whether home-based therapy is medically necessary in your case.

What happens if my physical therapy clinic is not a Medicare provider?

If your clinic is not enrolled as a Medicare provider, Medicare will not cover your visits, and you will be responsible for the full cost. Before starting therapy, ask the clinic directly whether they are enrolled as a Medicare provider. You can also check the Medicare provider directory on Medicare.gov.

Can I continue physical therapy after I reach my therapy goals?

Medicare covers therapy only while it is medically necessary and producing progress. Once you have reached your goals, Medicare will not cover maintenance therapy. Your doctor and therapist can discuss whether continued therapy is medically necessary or whether you should stop and do home exercises to maintain your progress.