Medicare covers physical therapy, but the number of sessions depends on your specific situation and which part of Medicare you have
Medicare Part B covers outpatient physical therapy up to a combined annual limit of $2,170 for 2024 (this dollar amount changes each year). This is not a limit on the number of sessions — it is a spending limit. How many actual sessions you receive depends on what your therapy costs and whether your doctor thinks the therapy is medically necessary.
If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage works differently. Each Advantage plan sets its own limits on physical therapy sessions, so you need to check your plan's documents or call the plan directly to learn what you are covered for.
Medicare also covers inpatient rehabilitation (physical therapy you receive while staying in a hospital or skilled nursing facility), but that follows different rules and is not part of the annual dollar limit.
Key Takeaways
- Original Medicare Part B covers outpatient physical therapy up to $2,170 per year in total spending, not a set number of sessions.
- Your doctor must order the physical therapy and document that it is medically necessary for Medicare to cover it.
- Medicare Advantage plans each set their own session limits, which may be more or less generous than Original Medicare.
- You pay 20 percent of the cost after you meet your Part B deductible, and the full cost counts toward your annual limit.
- If you reach your limit before the year ends, you can still receive therapy but you will pay the full cost yourself.
How the annual dollar limit works in practice
The $2,170 limit is a spending cap, not a session cap. If your physical therapy costs $50 per session, you could receive about 43 sessions before hitting the limit. If your therapy costs $100 per session, you would hit the limit around 22 sessions. The actual number of sessions you get depends on the cost of therapy in your area and at your specific clinic.
The limit applies to the calendar year (January through December). Once you reach $2,170 in spending, Medicare stops paying for outpatient physical therapy for the rest of that year. You can start fresh on January 1 of the next year.
Your out-of-pocket cost counts toward this limit. After you meet your Part B deductible (which is $240 for 2024), you pay 20 percent of the Medicare-approved amount for each session. That 20 percent is part of what counts toward your $2,170 limit.
What Medicare requires before covering physical therapy
Your doctor must order physical therapy and state that it is medically necessary. Medicare does not cover therapy for general wellness, fitness, or prevention. The therapy must be treating a specific condition — such as recovering from surgery, stroke, fracture, or a chronic condition like arthritis that is limiting your movement.
Your physical therapist must also document progress. If Medicare reviewers determine that you are not making meaningful progress toward your treatment goals, they may stop covering additional sessions even if you have not reached your annual limit. This is called a medical necessity review.
Some conditions have specific rules. For example, if you are receiving physical therapy for the same condition in more than one setting (such as both outpatient clinic and home health), the sessions may count toward the same annual limit.
The difference between Original Medicare and Medicare Advantage
If you have Original Medicare (Part A and Part B), you follow the $2,170 annual limit described above. You can receive therapy at any clinic or hospital that accepts Medicare.
If you have a Medicare Advantage plan, the plan itself decides how many physical therapy sessions it will cover. Some Advantage plans cover the same $2,170 limit as Original Medicare. Others cover more sessions, fewer sessions, or require you to stay within a specific network of providers. A few plans cover unlimited sessions, though this is less common.
You must check your Advantage plan's summary of benefits or call the plan's customer service line to learn your specific coverage. The plan documents will tell you the session limit, whether you need a referral, and whether you must use in-network providers.
Physical therapy in hospitals and skilled nursing facilities
If you receive physical therapy while admitted to a hospital or skilled nursing facility, it is covered under Medicare Part A (hospital insurance), not Part B. This therapy does not count toward your $2,170 annual limit.
For a skilled nursing facility stay to be covered, you must have been admitted to a hospital for at least three consecutive days first, and your doctor must order the skilled nursing care. Physical therapy is part of that care and is included in your daily copay (which is $0 for days 1–20, and $200 per day for days 21–100 in 2024).
What happens when you reach your annual limit
Once you have spent $2,170 on outpatient physical therapy in a calendar year, Medicare stops paying. You can still receive physical therapy, but you will pay the full cost yourself. Some clinics may offer a discounted rate for uninsured patients, so it is worth asking.
If you reach your limit partway through the year and still need therapy, talk to your doctor about whether the therapy can wait until January, or whether there are other treatments that might help in the meantime. Some people choose to pay out of pocket for a few sessions to finish their course of treatment before the year ends.
How to find out your current spending and remaining coverage
You can check how much of your $2,170 limit you have used by logging into your Medicare account at Medicare.gov or by calling Medicare at 1-800-MEDICARE (1-800-633-4227). Your physical therapy clinic can also tell you how much Medicare has paid on your behalf and how much of your limit remains.
If you have a Medicare Advantage plan, log into your plan's website or call the customer service number on your insurance card. Advantage plans track their own limits, which may be different from the Original Medicare limit.
Keep your own records too. Ask your clinic for an explanation of benefits (EOB) after each session, which shows what Medicare paid and what you paid. This helps you track your progress toward the annual limit.
Questions to ask your doctor and physical therapist
Before you start physical therapy, ask your doctor: "How many sessions do you think I will need?" and "Is this therapy medically necessary, and will you document that for Medicare?" These questions help you understand what to expect and may support your doctor is providing the information Medicare needs.
Ask your physical therapist: "What is the cost per session?" and "Can you tell me how much of my annual limit I have used after each visit?" Also ask: "If I reach my limit before my treatment is done, what are my options?" Some clinics offer sliding-scale fees or payment plans for patients who run out of coverage.
Frequently Asked Questions
Can I get more than $2,170 worth of physical therapy in a year?
Only if your doctor requests a therapy cap exception from Medicare and Medicare approves it. Your therapist can help submit this request if they believe you need more sessions than the limit allows and that you are making progress. Medicare reviews these requests case by case, so approval is not may provide.
Does my Medicare Supplement plan help pay for physical therapy?
A Medigap (Medicare Supplement) plan covers some of your out-of-pocket costs, such as your 20 percent coinsurance and deductible. It does not increase your session limit or annual spending limit. The limit is set by Medicare Part B, not by your supplement plan.
What if my physical therapist is out of network?
Original Medicare covers out-of-network providers as long as they accept Medicare. You pay 20 percent of the Medicare-approved amount. If you have a Medicare Advantage plan, using an out-of-network provider may cost you more or may not be covered at all, depending on your plan.
Do I need a referral from my doctor to start physical therapy?
Original Medicare does not require a referral, but your doctor must order the therapy and document that it is medically necessary. Medicare Advantage plans may require a referral, so check your plan documents or call your plan before scheduling.
What if I disagree with Medicare's decision to stop covering my therapy?
You have the right to appeal. Ask your physical therapist or doctor to help you submit an appeal explaining why you believe you need more sessions. Medicare will review your medical records and treatment progress. The appeals process can take several weeks.