Medicare Part B covers physical therapy, but only when ordered by a doctor for a medical condition and delivered by a licensed therapist.

Medicare will pay for physical therapy (PT) if your doctor prescribes it to treat an injury, illness, or surgery recovery. You do not need to be in a hospital — you can receive PT in an outpatient clinic, your home, or a skilled nursing facility. Medicare Part B is the part that pays, and you will pay a coinsurance (usually 20% of the cost after you meet your deductible).

The key requirement is that a doctor must order the therapy and document that it is medically necessary. Medicare will not pay for PT you arrange on your own, even if a therapist recommends it. The therapist must also be enrolled in Medicare and licensed in your state.

Key Takeaways

  • Your doctor must order physical therapy in writing, and the therapist must be Medicare-enrolled for Medicare to pay.
  • You pay 20% coinsurance after you meet your Part B deductible, unless you have a Medigap or Medicare Advantage plan that covers more.
  • Medicare sets a yearly limit on how much it will pay for PT combined with occupational therapy and speech therapy — the limit changes each year.
  • Home-based PT is covered if your doctor documents that you are homebound or cannot safely travel to a clinic.
  • You should ask your doctor's office to verify coverage before your first appointment so you know what you will owe.

How Medicare decides what PT costs you

When your doctor orders PT, Medicare Part B pays 80% of what it considers the "allowed amount" for that service in your area. You pay the remaining 20% as coinsurance. Before Medicare pays anything, you must first meet your Part B deductible for the year (the amount changes annually). Once you reach that deductible, the 80/20 split begins.

The actual bill from the therapy clinic may be higher than Medicare's allowed amount. If the clinic is a Medicare provider, they have agreed to accept Medicare's allowed amount as payment in full — you will not owe the difference. If the clinic is not a Medicare provider, you may owe extra charges on top of your coinsurance.

If you have a Medigap (supplemental insurance) or a Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20% coinsurance. Medicare Advantage plans have their own rules about PT coverage and may require you to use therapists in their network. Check your plan documents or call the plan before scheduling.

The yearly limit on PT and related therapies

Medicare sets a combined yearly limit on how much it will pay for physical therapy, occupational therapy, and speech therapy together. This limit applies to outpatient services only — it does not explore to PT you receive in a hospital, skilled nursing facility, or as part of home health care. The dollar amount of the limit changes each year and is set by Congress.

Once you and your providers reach that limit, Medicare stops paying. You can still receive PT after the limit is reached, but you will owe the full cost unless your doctor submits a request for an exception. Some exceptions are granted if your condition requires ongoing therapy and you are making progress. Your therapist or doctor's office can submit this request on your behalf.

When your doctor orders PT at home

Medicare covers home-based physical therapy if your doctor documents that you are homebound — meaning you cannot leave home without considerable difficulty or information, or leaving home poses a medical risk. Your doctor must also state that skilled nursing or therapy is needed and that you cannot receive the same care in an outpatient setting.

Home PT is usually ordered after a hospital stay or when you have mobility problems that make clinic visits unsafe. A Medicare-approved home health agency will arrange the therapist visit. The same 20% coinsurance applies, and the visits count toward your yearly therapy limit.

What to do before your first PT appointment

Ask your doctor's office to write the PT order and send it to the clinic you plan to use. Before you go to your first appointment, call the clinic and ask them to verify your Medicare coverage. Give them your Medicare number, and they can tell you whether they accept Medicare, what your coinsurance will be, and whether you have met your deductible for the year.

Also ask the clinic whether they are a Medicare provider (meaning they accept Medicare's allowed amount as full payment) or whether they bill above that amount. If they are not a Medicare provider, ask what the extra charges will be. This step takes 10 minutes and prevents surprise bills later.

If you have a Medicare Advantage plan, call your plan first to find out which therapists are in-network and whether you need a referral. Some Medicare Advantage plans require prior approval before PT begins.

PT in a skilled nursing facility or after hospitalization

If you are admitted to a skilled nursing facility (SNF) after a hospital stay, Medicare Part A covers your room, meals, and nursing care for up to 100 days. Physical therapy provided during your SNF stay is included in that coverage — you do not pay separately for PT as long as you are a covered patient. You may owe a daily copay for days 21 through 100 of your stay.

Once you leave the SNF, if your doctor orders outpatient PT to continue your recovery, Medicare Part B takes over and the 20% coinsurance and yearly limit explore again.

What Medicare does not cover for PT

Medicare does not pay for PT ordered for general wellness, fitness, or prevention — only for treatment of a specific medical condition. If you want PT to improve balance or strength as a preventive measure, Medicare will not cover it. You would pay out of pocket.

Medicare also does not cover PT that is not ordered by a doctor, even if a therapist thinks you need it. Some therapists offer direct access (meaning you can see them without a doctor's order), but Medicare will not pay for those visits.

Frequently Asked Questions

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

Any doctor can order PT — your primary care doctor, a specialist, or an urgent care doctor. The order just needs to be written and include the diagnosis and medical reason for therapy. You do not need a separate referral.

What happens if I reach the yearly PT limit before I finish my treatment?

Once you hit the limit, Medicare stops paying. Your therapist or doctor can request an exception from Medicare if you are still making progress and need more sessions. The request is submitted in writing and Medicare reviews it. Some exceptions are granted, but not all.

If I have a Medicare Advantage plan, do I still have the yearly PT limit?

Medicare Advantage plans must cover at least as much PT as Original Medicare does, but they set their own rules about copays, coinsurance, and network requirements. Some plans have higher limits or lower out-of-pocket costs. Check your plan documents or call the plan to find out.

Can I choose any physical therapist, or do they have to be in-network?

With Original Medicare (Part A and B), you can see any Medicare-enrolled therapist — there is no network. With a Medicare Advantage plan, you usually must use in-network providers or pay more. Check your plan's provider list before scheduling.

Will Medicare pay for PT if I had an injury at work?

No. If your injury is work-related, workers' compensation insurance should pay for your PT, not Medicare. You will need to file a workers' compensation claim with your employer's insurance carrier.