Medicare covers therapy, but only certain types and only when ordered by a doctor

Medicare Part B pays for physical therapy, occupational therapy, and speech-language pathology when a doctor orders them to treat an injury or illness. It does not cover long-term therapy for general wellness, and it does not cover most mental health counseling in the same way. You pay 20 percent of the cost after you meet your Part B deductible, and there are annual spending limits that reset each year.

The key difference is medical necessity: Medicare pays when therapy is meant to restore function after an event — a stroke, surgery, a fall — not when it is meant to maintain health or address ongoing mental health conditions without a specific medical trigger. Mental health therapy has its own rules, covered under a different part of Medicare with different cost-sharing.

Key Takeaways

  • Physical therapy, occupational therapy, and speech therapy are covered by Medicare Part B when a doctor orders them to treat a specific medical condition or injury.
  • You pay 20 percent of the approved cost after your Part B deductible, and there is an annual limit on how much Medicare will spend on these therapies combined.
  • Mental health counseling and psychotherapy are covered under Medicare Part B but with the same 20 percent cost-sharing, and you do not need a referral from a primary care doctor.
  • Therapy ordered in a hospital or skilled nursing facility during a covered stay is usually included in what the facility charges Medicare, not billed separately to you.
  • If your doctor says therapy is not medically necessary, Medicare will not pay, and you will owe the full cost unless you signed a form acknowledging that risk before treatment began.

Physical, Occupational, and Speech Therapy Coverage

Medicare Part B covers these three therapies when they are ordered by a doctor to treat a medical condition. Physical therapy helps you regain movement and strength after surgery, stroke, or injury. Occupational therapy helps you relearn daily tasks like dressing, cooking, or bathing after illness or injury. Speech therapy treats swallowing problems and speech difficulties caused by stroke, Parkinson's disease, or other conditions.

The therapist must be enrolled in Medicare and work in a setting Medicare recognizes — a clinic, your home, an outpatient hospital department, or a skilled nursing facility. You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible ($240 in 2024, though this changes yearly). There is also an annual cap: Medicare will not pay more than a certain amount per year for physical therapy and speech therapy combined, and a separate limit for occupational therapy. These caps reset on January 1 each year.

Your doctor must document that the therapy is medically necessary — that is, it treats a specific condition and has a reasonable chance of improving your function. If Medicare decides the therapy is not medically necessary, you will receive a notice called an Advance Beneficiary Notice before treatment starts. This notice tells you that Medicare may not pay and asks you to sign saying you understand the risk. If you sign and Medicare denies payment, you owe nothing. If you do not sign and Medicare denies payment, you may owe the full cost.

Mental Health Counseling and Psychotherapy

Medicare Part B covers mental health counseling and psychotherapy with a psychiatrist, psychologist, clinical social worker, or licensed counselor. You do not need a referral from your primary care doctor, and the therapist does not need to be treating a physical injury or illness — depression, anxiety, grief, and other mental health conditions are covered on their own.

You pay 20 percent of the Medicare-approved cost after your Part B deductible. There is no annual spending limit on mental health therapy the way there is for physical therapy. However, Medicare only pays for therapy that is medically necessary, meaning the therapist must document that you have a mental health condition that warrants treatment.

Telehealth mental health visits are covered by Medicare and have been since the COVID-19 pandemic began. Your therapist can be in a different state from you, though some states have their own licensing rules. Ask your therapist whether they accept Medicare and what their billing process is before your first appointment.

Therapy in Hospitals and Skilled Nursing Facilities

If you receive therapy as part of a hospital stay or during a covered stay in a skilled nursing facility, the cost is usually included in what the facility bills Medicare. You do not receive a separate bill for the therapy itself. Instead, you pay the facility's copay or coinsurance for the entire stay.

A skilled nursing facility stay is covered by Medicare Part A if you were hospitalized for at least three days and your doctor orders the facility stay for continued medical care. Therapy is part of that care and is included in the daily copay you owe (which is $0 for days 1–20, then $200 per day for days 21–100 in 2024). Once you leave the facility, if your doctor orders outpatient therapy, that therapy is covered under Part B with the 20 percent cost-sharing described above.

What Medicare Does Not Cover

Medicare does not cover therapy ordered for general wellness, fitness, or prevention when there is no medical condition being treated. A doctor cannot order therapy "to stay active" or "to prevent falls" — there must be a specific injury or illness that the therapy is meant to treat.

Medicare also does not cover long-term custodial care or maintenance therapy. If you have reached your maximum improvement and therapy is now meant to maintain your current level of function rather than improve it, Medicare will stop paying. Your therapist and doctor will discuss this with you, and you should ask when they expect therapy to end.

Experimental or unproven therapies are not covered. If your doctor wants to order a therapy that is not yet standard treatment for your condition, ask whether Medicare will pay before you begin.

How to Find a Medicare-Enrolled Therapist

Use the Medicare Provider Search tool on Medicare.gov to find physical therapists, occupational therapists, speech therapists, and mental health providers in your area who accept Medicare. Search by your zip code and the type of provider you need.

When you call a therapist's office, ask three things: whether they accept Medicare assignment (meaning they accept Medicare's approved amount as full payment), what your out-of-pocket cost will be, and whether they will submit the claim to Medicare or whether you need to do it. Most offices will handle the claim for you, but some require you to pay upfront and then file for reimbursement yourself.

If you have a Medigap or Medicare Advantage plan, check your plan documents or call your plan to see whether the plan covers any of the cost-sharing you would owe to Medicare. Some plans cover the 20 percent coinsurance; others do not.

Annual Therapy Limits and How They Work

For 2024, Medicare has an annual cap of $2,430 for physical therapy and speech therapy combined, and a separate cap of $2,430 for occupational therapy. These are the total amounts Medicare will pay in a calendar year; once the cap is reached, Medicare stops paying and you owe the full cost of further therapy.

The cap applies to therapy ordered by any doctor, in any setting — clinic, home, hospital outpatient department. If you see multiple therapists, the costs add up toward the same cap. Your therapist's office should track your spending toward the cap and tell you when you are approaching it.

Congress can change these caps, and they sometimes increase. Ask your therapist or call Medicare at 1-800-MEDICARE to find out the current year's limits.

What Happens if Medicare Denies Your Therapy Claim

If Medicare denies a claim for therapy, you will receive a notice called an Explanation of Benefits that explains why. Common reasons for denial are that Medicare decided the therapy was not medically necessary, that you have reached your annual cap, or that the therapist is not enrolled in Medicare.

You have the right to appeal. The notice will tell you how to file an appeal and what important date you have. You can ask your therapist's office to help you appeal, or you can do it yourself. If you disagree with the appeal decision, you can request a hearing before a Medicare administrative law judge.

If you believe you were not given proper notice that Medicare might not pay, you can file a complaint with your state's insurance commissioner or with Medicare directly.

Frequently Asked Questions

Do I need my primary care doctor's permission to see a mental health therapist?

No. Medicare Part B covers mental health therapy without a referral from your primary care doctor. You can contact a psychiatrist, psychologist, clinical social worker, or licensed counselor directly. However, it is a good idea to tell your primary care doctor that you are seeing a mental health provider so they have a complete picture of your care.

Will Medicare pay for therapy if I am in a Medicare Advantage plan?

Yes, but the rules may be different. Medicare Advantage plans must cover the same therapy services that Original Medicare covers, but they may have different copays, deductibles, or limits. Check your plan documents or call your plan to find out what you will owe.

What if my therapist says I need more therapy than Medicare's annual cap allows?

Once you reach the annual cap, Medicare will not pay for additional therapy that year. You can pay out of pocket, or you can wait until January 1 when the cap resets. Your therapist may also be able to document that you need therapy beyond the cap and request an exception, though Medicare does not always grant these.

Can I get therapy at home, and will Medicare pay for it?

Yes. Medicare covers physical therapy, occupational therapy, and speech therapy in your home when a doctor orders it and a Medicare-enrolled therapist provides it. Home therapy is often covered the same way as clinic therapy — you pay 20 percent after your deductible — though some therapists may charge differently for travel time.

If I have not met my Part B deductible, do I pay the full cost of therapy before Medicare starts paying?

Yes. You must meet your Part B deductible ($240 in 2024) before Medicare pays its share of any Part B service, including therapy. Once you meet the deductible, Medicare pays 80 percent and you pay 20 percent of the approved amount.