Medicare covers physical therapy, but the number of sessions depends on your plan and whether your therapist accepts Medicare

Medicare Part B covers physical therapy when a doctor orders it for a medical reason — not for general fitness or wellness. The coverage works differently depending on whether you have Original Medicare or a Medicare Advantage plan, and it changes based on where you receive treatment and what your therapist's contract with Medicare looks like.

Original Medicare Part B does not set a fixed number of sessions per year. Instead, it uses a dollar threshold: you pay nothing once you meet your annual deductible, then Medicare pays 80 percent of the approved amount for each session, and you pay 20 percent. The threshold that matters is the total dollar amount Medicare will reimburse in a calendar year, which varies and depends on the specific therapy code your provider uses. Medicare Advantage plans set their own limits, which can be more or less generous than Original Medicare.

Key Takeaways

  • Original Medicare Part B covers physical therapy ordered by a doctor for a medical condition, paying 80 percent of the approved cost after you meet your deductible.
  • Medicare does not limit sessions by a fixed number; instead, coverage is based on medical necessity and the total dollar amount Medicare will pay in a calendar year.
  • Medicare Advantage plans each set their own session limits and cost-sharing rules, so you need to check your specific plan's documents.
  • Your therapist's Medicare contract status affects your out-of-pocket cost: in-network therapists bill Medicare directly, while out-of-network therapists may charge you more.
  • Your doctor's referral must state that therapy is medically necessary; Medicare will not cover sessions that continue after your condition has improved enough to stop.

How Original Medicare Part B Covers Physical Therapy

Under Original Medicare Part B, physical therapy is covered when ordered by your doctor for a condition that requires it — such as recovery after surgery, stroke, joint replacement, or a fall. Your doctor writes the referral, and the therapist submits claims to Medicare on your behalf if they accept Medicare assignment.

You pay your annual Part B deductible first (the amount changes each year). After that, Medicare pays 80 percent of the approved amount for each session, and you pay 20 percent. The approved amount is set by Medicare, not by what the therapist charges. If your therapist does not accept Medicare assignment, they can charge you more, and you may owe the difference between what they charge and what Medicare approves.

The key limit is not a session count but a dollar threshold. Medicare will cover physical therapy as long as it remains medically necessary and the total amount Medicare pays stays within the annual limit for that therapy code. If your therapist documents that you need more sessions to reach your therapy goals, Medicare may continue to cover them. If your condition improves and your therapist notes that you no longer need treatment, coverage stops.

Medicare Advantage Plans Set Their Own Session Limits

If you have a Medicare Advantage plan (Part C), your plan document spells out how many physical therapy sessions are covered per year and what you pay for each one. Some plans cover 20 sessions per year, others cover 30, and some cover more. A few plans cover an unlimited number if the therapy is deemed medically necessary, but this is less common.

You need to check your plan's Summary of Benefits or call the plan's customer service number to find out your specific limit. The limit may differ depending on whether you go to an in-network therapist or an out-of-network one. Some plans require prior approval before you start therapy, meaning your doctor's referral must be submitted to the plan for review before your first session.

Medicare Advantage plans can change their coverage rules each year during the annual enrollment period, so even if you know your limit from last year, check your updated documents for the current year.

Where You Receive Therapy Affects Coverage

Physical therapy can happen in an outpatient clinic, a hospital outpatient department, your home, or a skilled nursing facility. Medicare covers therapy in all these settings, but the billing and limits may differ.

Outpatient clinic therapy is the most common setting and follows the rules described above. Home health physical therapy is covered if you are homebound and a doctor orders it, but it is billed under a different Medicare benefit with its own rules. Therapy in a skilled nursing facility is covered as part of your stay if you were admitted after a hospital stay of at least three days. Hospital outpatient therapy is also covered but may have different cost-sharing rules than a private clinic.

Ask your therapist or doctor which setting makes sense for your situation, and confirm with your insurance that the specific location is in-network if you have a Medicare Advantage plan.

What Happens When You Reach Your Limit

If you have Original Medicare and reach the annual dollar threshold, Medicare will stop paying for additional sessions that calendar year. You can still receive therapy, but you will pay the full cost out of pocket unless your therapist offers a reduced rate for uninsured patients.

If you have a Medicare Advantage plan and use all your covered sessions, you can request an exception from your plan if your doctor believes more sessions are medically necessary. The plan will review the request and may approve additional sessions. If the plan denies the request, you can file an appeal or pay out of pocket.

Coverage restarts on January 1 of the next calendar year under Original Medicare, or on your plan's benefit year start date if you have Medicare Advantage.

In-Network Versus Out-of-Network Therapists

If your therapist accepts Medicare assignment, they bill Medicare directly and you pay only your 20 percent coinsurance (after your deductible) under Original Medicare. This is the most predictable cost.

If your therapist does not accept Medicare assignment, they can charge you more than Medicare's approved amount. You may owe the difference between their charge and what Medicare approves. Some therapists will write off this difference; others will bill you for it. Ask your therapist's office about their billing policy before your first session.

If you have a Medicare Advantage plan, using an in-network therapist is almost always cheaper. Out-of-network therapists may charge more, and your plan may not cover as much of the cost. Check your plan's provider directory to find in-network physical therapists in your area.

How to get your free guide With Physical Therapy

Your doctor must order physical therapy and document that it is medically necessary. The therapist will submit the referral to Medicare (or your Medicare Advantage plan) along with an initial evaluation. Medicare or your plan will review the referral and approve or deny coverage.

If you have Original Medicare, you can usually start therapy right away while the claim is being processed. If you have a Medicare Advantage plan, some plans require prior approval before your first session, so ask your plan whether you need approval first.

Bring your Medicare card to your first appointment. The therapist's office will verify your coverage and tell you what your out-of-pocket cost will be for each session. Ask them to estimate your total cost based on the number of sessions your doctor recommended.

Frequently Asked Questions

Can I choose my own physical therapist, or does Medicare require me to use a specific one?

You can choose any therapist who accepts Medicare. If you have Original Medicare, the therapist does not have to be on a list. If you have a Medicare Advantage plan, you should use an in-network therapist to keep your costs down, but check your plan's rules — some plans allow out-of-network care at a higher cost.

What if my doctor says I need more sessions than Medicare will cover?

If you have Original Medicare and reach the dollar limit, you can continue therapy and pay out of pocket. If you have a Medicare Advantage plan and reach your session limit, ask your doctor to request an exception from your plan. The plan will review whether more sessions are medically necessary and may approve them.

Does Medicare cover physical therapy for arthritis or general pain relief?

Medicare covers physical therapy for arthritis or pain only if a doctor orders it as treatment for a specific medical condition and documents that it is medically necessary. Therapy for general wellness or fitness is not covered. Your doctor's referral must explain why therapy is needed for your condition.

If I switch from Original Medicare to a Medicare Advantage plan mid-year, what happens to my therapy?

You cannot switch to a Medicare Advantage plan mid-year unless you have a may have access to life event. If you do switch, your new plan's rules take effect when ready. Any sessions you used under Original Medicare do not count toward your new plan's annual limit, so you start fresh with your plan's coverage rules.

Do I need a new referral each year, or does one referral cover multiple years?

A referral from your doctor is usually good for a set period — often 30 days to a few months, depending on your condition and what your doctor writes. If you need therapy beyond that period, your therapist will ask your doctor for a new referral. Medicare and Medicare Advantage plans may also require updated documentation of medical necessity if therapy continues for a long time.