Medicare covers up to 60 physical therapy visits per year, but the actual number you receive depends on your specific plan and whether your doctor thinks the visits are medically necessary

Original Medicare (Part A and Part B) sets an annual limit of 60 visits combined for physical therapy and occupational therapy together. This means if you use 40 physical therapy visits, you have 20 left for occupational therapy, or vice versa. Medicare Part B pays for 80 percent of the cost after you meet your yearly deductible; you pay the remaining 20 percent.

If you have a Medicare Advantage plan (Part C), your coverage may differ. Some plans offer the same 60-visit limit, while others may offer more visits or fewer. You need to check your specific plan's documents or call the plan directly to learn what your coverage includes.

The visits must be ordered by your doctor and deemed medically necessary for a condition like stroke recovery, arthritis, or post-surgical rehabilitation. Medicare will not cover visits for general fitness, wellness, or maintenance once you have reached your functional goals.

Key Takeaways

  • Original Medicare covers up to 60 physical therapy visits per year when combined with occupational therapy visits, after you meet your Part B deductible.
  • Medicare Advantage plans may offer different visit limits, so you must review your plan documents or contact your plan to confirm your coverage.
  • Your doctor must order the visits and document that they are medically necessary for your condition, not for general fitness or maintenance.
  • You pay 20 percent of the cost for each visit under Original Medicare after meeting your deductible; Medicare Advantage copays vary by plan.
  • Once you reach your functional goals, Medicare will not continue to cover visits, even if you have visits remaining in your annual limit.

How the 60-Visit Limit Works in Practice

The 60-visit limit is an annual cap, meaning it resets on January 1 each year. If you use 45 visits between January and June, you have 15 visits remaining for the rest of that calendar year. On January 1 of the next year, your count resets to 60.

Physical therapy and occupational therapy visits share this same pool. If your doctor orders both types of therapy — for example, physical therapy for knee recovery and occupational therapy to help you dress and bathe independently — the visits are subtracted from the same 60-visit annual total. Speech-language pathology visits have a separate 60-visit annual limit.

The limit applies whether you receive therapy in an outpatient clinic, your home, a hospital outpatient department, or a skilled nursing facility. The setting does not change the number of visits Medicare will cover.

When Your Doctor Must Request More Visits

If your therapist believes you need more than 60 visits in a year, your doctor can request an exception through a process called a manual review. This is not automatic; your doctor must document in detail why the additional visits are medically necessary and how they will improve your function or prevent decline.

Medicare reviews these requests on a case-by-case basis. Approval is not may provide. The review typically takes one to two weeks. During this time, your therapy may continue, but you and your provider should understand that the additional visits may not be covered if Medicare denies the request.

Your therapist or doctor's office usually handles submitting the manual review request, but you can ask them directly about the status. If Medicare denies the request, you have the right to appeal the decision.

What Happens When You Reach Your Visit Limit

Once you have used all 60 visits, Medicare stops covering physical therapy unless your doctor has obtained prior approval for additional visits. Your therapist will tell you when you are approaching your limit — typically when you have used 50 or 55 visits.

At that point, you have three options: stop therapy, continue paying out of pocket, or ask your doctor to request a manual review for more visits. If you continue therapy without Medicare coverage and without an approved exception, you will be responsible for the full cost of each visit.

Some therapists offer reduced rates for patients paying out of pocket, so it is worth asking. You can also ask your therapist to document your progress and remaining functional goals, which may help your doctor make a stronger case for additional covered visits.

Medicare Advantage Plans and Physical Therapy Coverage

Medicare Advantage plans must cover at least the same amount of physical therapy as Original Medicare — 60 visits per year — but many plans offer more. Some plans cover 80 or 100 visits annually, or they may have no visit limit at all.

The trade-off is usually a higher copay per visit. Original Medicare charges 20 percent coinsurance after your deductible; a Medicare Advantage plan might charge $25 to $50 per visit instead. Over 60 visits, this can add up significantly.

To find out what your specific Medicare Advantage plan covers, check the plan's Summary of Benefits and Coverage document, which you received when you enrolled. You can also call the plan's customer service number on your insurance card and ask directly: "How many physical therapy visits does my plan cover per year, and what is my copay?"

How to Prepare Before Your First Physical Therapy Visit

Before you start physical therapy, confirm with your doctor that they will order the visits and that they believe the therapy is medically necessary. Without a doctor's order, Medicare will not cover any visits, regardless of how many you might need.

Call your physical therapy clinic and ask them to verify your Medicare coverage before your first appointment. They can contact Medicare or your plan to confirm your deductible status, copay amount, and visit limit. This prevents surprises at the front desk.

Bring your Medicare card and any other insurance cards to your first visit. The clinic will use this information to bill correctly. Ask the clinic staff to explain your out-of-pocket costs and to tell you when you are approaching your annual visit limit.

Questions to Ask Your Doctor and Therapist

Before starting physical therapy, ask your doctor: "How many visits do you think I will need, and will that fit within Medicare's 60-visit annual limit?" This gives you a realistic picture of your treatment plan.

Ask your physical therapist: "How will you track my progress, and when will we know I have reached my functional goals?" This helps you understand when therapy is expected to end and prevents unnecessary visits that Medicare may not cover.

If you are nearing your 60-visit limit, ask your therapist: "Do you think I need more visits than Medicare covers? If so, what documentation should my doctor provide to request an exception?" This gives your doctor time to prepare a strong case if additional visits are truly necessary.

Frequently Asked Questions

Does Medicare cover physical therapy for arthritis or chronic pain?

Yes, if your doctor orders it and believes it will improve your function or prevent decline. Medicare covers therapy for arthritis-related pain and stiffness, but not for general wellness or pain management alone. Your therapist must document measurable progress toward specific functional goals.

What if I have both Original Medicare and a Medigap plan?

Your Medigap plan does not increase your physical therapy visit limit. Original Medicare's 60-visit annual cap still applies. However, your Medigap plan may cover some or all of your 20 percent coinsurance, reducing your out-of-pocket cost per visit.

Can I switch to a different physical therapist and keep my remaining visits?

Yes. Your 60-visit annual limit follows you, not the clinic. If you have used 30 visits at one clinic and switch to another, you have 30 visits remaining for the rest of that calendar year, regardless of which therapist provides them.

Do telehealth physical therapy visits count toward my 60-visit limit?

Yes, telehealth visits count the same as in-person visits. Medicare covers remote physical therapy when ordered by your doctor and provided by a licensed therapist, and these visits are subtracted from your annual 60-visit limit.

What if my doctor says I need therapy but Medicare denies it as not medically necessary?

You have the right to appeal Medicare's decision. Ask your doctor or therapist to submit an appeal with detailed documentation of your condition and why the therapy is necessary. The appeal process typically takes two to four weeks.