Medicare covers up to 60 physical therapy visits per year, but the real limit depends on medical necessity

Medicare Part B pays for physical therapy if your doctor orders it to treat a specific condition — a stroke, knee surgery, arthritis, or similar injury. The program does not have a hard annual cap. Instead, it uses a system called the therapy cap, which sets a dollar limit rather than a visit limit. Once your physical therapy bills reach that dollar amount in a calendar year, Medicare stops paying until the next year begins.

The dollar cap changes each year. For 2024, the therapy cap is $2,170 per patient per year. The number of visits you actually receive depends on how much each session costs in your area and what your therapist charges. In most places, a single physical therapy session costs between $30 and $80 after Medicare's payment, so 60 visits is a rough average — but your actual number could be higher or lower.

There is an exception: if your therapist documents that continued treatment is medically necessary beyond the cap, you can request an override. Medicare calls this a therapy cap exception. Your therapist must submit the request with clinical notes explaining why stopping treatment would harm your recovery. This is not automatic, and not every request is approved, but it is the main way people receive more than the standard cap allows.

Key Takeaways

  • Medicare covers physical therapy ordered by your doctor, but limits payment to a dollar amount per year ($2,170 in 2024), not a set number of visits.
  • The number of sessions you receive depends on what your therapist charges; 60 visits is typical but varies by location and provider.
  • Your therapist can request a therapy cap exception if your medical condition requires more treatment, but the request must include clinical documentation.
  • You pay 20 percent of the Medicare-approved amount for each session after you meet your Part B deductible.
  • Physical therapy ordered in an outpatient hospital setting may have different payment rules than therapy in a private clinic.

How the therapy cap works in practice

The therapy cap is a dollar limit, not a visit limit. Medicare sets the amount each year, and once your therapist's bills total that amount, Medicare stops paying for additional sessions in that calendar year. The cap resets on January 1.

Your out-of-pocket cost per session is 20 percent of the Medicare-approved amount, after you have paid your Part B deductible ($240 in 2024). So if a session is approved at $100, you pay $20 and Medicare pays $80. That $80 counts toward your therapy cap. Once the cap is reached, you either stop therapy or pay the full cost yourself.

The cap applies to all outpatient therapy combined — physical therapy, occupational therapy, and speech-language pathology together share the same $2,170 limit. If you are receiving occupational therapy for a hand injury and physical therapy for a knee injury at the same time, both count toward the same annual cap.

When you can request more sessions than the cap allows

Medicare allows your therapist to request a therapy cap exception if your condition requires ongoing treatment beyond the standard limit. The request must show that stopping therapy would result in a decline in your function or health status. Common reasons include complex fractures, multiple joint surgeries, or neurological conditions like stroke or Parkinson's disease.

Your therapist submits the exception request to Medicare along with clinical documentation: progress notes, test results, functional measurements, and an explanation of why continued treatment is medically necessary. Medicare reviews the request and either approves it (allowing more sessions) or denies it (the cap stays in place).

The exception process takes time — usually two to four weeks. During that time, your therapist may continue treating you, but you should understand that if the exception is denied, you may owe the full cost of those sessions. Ask your therapist whether they will continue treatment while the request is pending and what your financial responsibility would be if it is denied.

Physical therapy in different settings and how payment changes

The therapy cap applies to outpatient physical therapy in a clinic, your home, or a therapist's office. But if you receive physical therapy in an outpatient hospital department, the payment rules are different. Hospital outpatient therapy is subject to a separate cap, also $2,170 in 2024, and you may pay a higher coinsurance amount (up to 40 percent instead of 20 percent).

If you are in a skilled nursing facility (SNF) after a hospital stay, physical therapy is included in your daily SNF rate, not subject to the therapy cap. Medicare covers up to 100 days of SNF care, and therapy is part of that benefit. Once you leave the SNF, the outpatient therapy cap applies again.

Inpatient hospital rehabilitation is also not subject to the therapy cap — it is covered as part of your hospital stay. The difference matters: if you need intensive therapy after surgery, inpatient rehabilitation or SNF care may give you more sessions than outpatient therapy would, because the cap does not explore.

What you need to know about your therapist's billing

Your physical therapist must be enrolled in Medicare and bill Medicare directly for you to receive the benefit. Not all therapists accept Medicare, so confirm this before your first appointment. If your therapist does not accept Medicare, you will pay out of pocket and will not receive any Medicare benefit.

Your therapist should give you an estimate of how many sessions they think you will need and track your progress toward the therapy cap. Ask them to tell you when you are approaching the cap so you are not surprised when Medicare stops paying. Some therapists will continue treating you after the cap is reached if you agree to pay the full cost; others will not.

Keep copies of your Medicare Explanation of Benefits (EOB) statements. These show what Medicare paid, what you paid, and how much of your therapy cap you have used. If there is a billing error, the EOB is your proof.

How to request a therapy cap exception

You do not request the exception yourself — your physical therapist does. But you should know what to expect. Your therapist will gather your medical records, progress notes, and functional test results, then submit a formal request to Medicare with a clinical justification for why you need more sessions.

Medicare reviews the request within 14 days and sends a decision to your therapist. If approved, you can continue therapy beyond the cap. If denied, your therapist will tell you, and you can choose to pay out of pocket or stop treatment.

If the exception is denied and you disagree, you have the right to appeal. Your therapist can help you file an appeal, which goes through Medicare's standard appeals process. This takes longer — usually 30 to 60 days — but it is an option if you believe the denial was wrong.

Frequently Asked Questions

Does the therapy cap reset if I switch therapists?

No. The cap is tied to you, not to your therapist. If you change providers mid-year, the new therapist's bills still count toward the same annual limit. The cap resets only on January 1.

What happens if my therapist bills me after the cap is reached?

Your therapist should stop billing Medicare once the cap is reached. If they continue and bill you for the full cost, you can dispute the charge. Ask your therapist in writing to confirm when the cap will be reached and what your responsibility is after that point.

Can I use my Medigap or Medicare Advantage plan to cover therapy beyond the cap?

Medigap plans do not cover therapy beyond Medicare's cap. Medicare Advantage plans may have different rules — some offer additional therapy sessions — so check your plan documents or call your plan to ask.

Do I need a new doctor's order for physical therapy each year?

Your original order from your doctor is usually good for one year. After that, your therapist will need a new order to continue treatment. Your doctor can write a new order if your condition still requires therapy.

What if my doctor says I need therapy but Medicare denies the exception request?

You can appeal Medicare's denial. Your therapist or doctor can file an appeal on your behalf, or you can do it yourself. You have 180 days from the denial date to file. The appeals process is slow but is your option if you believe the decision was wrong.