What Medicare Pays for Physical Therapy, Speech Therapy, and Other Rehabilitation Sessions

Medicare's Payment for Therapy Sessions

Medicare covers therapy sessions, but the amount it pays depends on the type of therapy, where you receive it, and whether you meet the program's requirements. Medicare Part B pays for physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor for a medical reason — not for general wellness or maintenance. The payment is typically 80 percent of the approved amount after you meet your Part B deductible, which means you pay the remaining 20 percent.

The actual dollar amount Medicare pays varies by location and the specific therapy code used. A physical therapy session in one state may be reimbursed at a different rate than the same session in another state, because Medicare uses a Geographic Practice Cost Index to adjust payments by region. In 2024, approved amounts for a typical 45-minute therapy session ranged from roughly $60 to $150 depending on location and complexity, but these figures change annually.

Key Takeaways

Medicare Part B covers physical therapy, occupational therapy, and speech therapy when a doctor orders them for a medical condition, and you pay 20 percent of the approved amount after meeting your deductible.
Medicare sets an annual spending limit for therapy services — currently $2,180 per year for physical therapy and occupational therapy combined, and a separate $2,180 for speech therapy — though your doctor can request an exception.
The amount Medicare pays per session varies by your location and the specific therapy code, so calling your therapist's billing office before your first visit will tell you the exact cost you will owe.
Therapy in a hospital outpatient department, skilled nursing facility, or your home may be covered under different rules than therapy in a private clinic.
If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower than the standard 20 percent, depending on your plan's coverage.

How Medicare Calculates Its Payment

Medicare does not pay the therapist's full bill. Instead, it pays a percentage of an approved amount — a fee that Medicare has determined is reasonable for that service in your area. The therapist may charge more than the approved amount, but Medicare will only pay based on the lower figure. If your therapist is in-network (accepts Medicare assignment), they agree to accept Medicare's approved amount as payment in full for their portion, and you owe only your 20 percent coinsurance.

If your therapist does not accept Medicare assignment, they can charge you more than the approved amount, and you may owe the difference on top of your coinsurance. Before scheduling therapy, ask the billing office whether the therapist accepts Medicare assignment and what the approved amount is for your specific therapy code.

Your Part B deductible for 2024 is $240 (this amount changes each year). You must pay this amount out of pocket before Medicare begins paying its share. Once you meet the deductible, Medicare pays 80 percent and you pay 20 percent for the rest of the calendar year.

Annual Spending Limits and How to Request an Exception

Medicare sets an annual cap on how much it will pay for therapy services. For 2024, the limit is $2,180 per year for physical therapy and occupational therapy combined, and a separate $2,180 for speech-language pathology. Once you reach this limit, Medicare stops paying, and you are responsible for the full cost of further sessions that year.

However, your doctor can request a manual medical review exception if your condition requires more therapy than the cap allows. The request must document why additional sessions are medically necessary. Medicare reviews these requests and may approve more sessions beyond the annual limit. The process typically takes one to two weeks. Your therapist's office can submit this request on your behalf, but you should ask them to do so before you run out of covered sessions.

Where You Receive Therapy Affects Coverage

Medicare covers therapy in several settings, but the payment rules and your out-of-pocket costs differ slightly:

Private therapy clinic or office: You pay 20 percent coinsurance after your deductible. This is the most common setting.
Hospital outpatient department: You may owe a copay instead of coinsurance, typically $50 to $250 per visit depending on your plan. Hospital outpatient therapy counts toward your annual limit.
Skilled nursing facility (SNF): If you are admitted to a SNF after a hospital stay, therapy is usually covered under Part A (your hospital benefit) with no separate charge, as long as you are within your benefit period. This therapy does not count toward your Part B annual limit.
Your home: Medicare covers home health therapy when ordered by a doctor and delivered by a Medicare-certified home health agency. You typically pay nothing for home health services covered under Part A, though some services may have a small copay.

What Therapy Sessions Must Be Ordered By a Doctor

Medicare will not pay for therapy that you start on your own, even if a therapist thinks it would help. A physician, nurse practitioner, or physician assistant must order the therapy and document that it is medically necessary for your condition. The order must be in writing and include the diagnosis, the type of therapy needed, and the expected duration.

Common reasons Medicare covers therapy include recovery from stroke, hip or knee replacement, heart attack, spinal cord injury, arthritis, Parkinson's disease, and other conditions that limit your ability to function. Therapy for general fitness, weight loss, or wellness — even if recommended by a therapist — is not covered.

If You Have a Medigap or Medicare Advantage Plan

Your out-of-pocket cost for therapy may be different if you have supplemental coverage. Medigap plans typically cover some or all of your 20 percent coinsurance, depending on which plan you have. Plans C, D, G, and M cover the full coinsurance; other plans cover part of it. Check your plan documents or call your Medigap insurer to confirm what therapy coinsurance is covered.

Medicare Advantage plans (Part C) set their own copays and coinsurance for therapy. Some plans charge a flat copay per session (for example, $30 to $50), while others charge coinsurance. Many Advantage plans also have their own annual limits for therapy that may be lower than Medicare's standard limit. Contact your Advantage plan before starting therapy to learn your exact cost.

How to Find Out What You Will Owe

The most reliable way to learn what Medicare will pay and what you will owe is to contact the therapy provider's billing office directly. Give them your Medicare number and ask for the following information:

The approved amount Medicare pays for the specific therapy code your doctor ordered.
Whether the therapist accepts Medicare assignment.
Your estimated out-of-pocket cost per session (usually 20 percent of the approved amount, minus any deductible already met).
How many sessions are covered under your annual limit and how many you have already used.
Whether your therapy will be billed under Part A or Part B (this affects your cost).

If you have a Medigap or Medicare Advantage plan, also contact that plan's customer service to confirm what portion of therapy costs they cover. Having this information before your first session prevents surprise bills later.

Frequently Asked Questions

What happens if I go over the annual therapy limit?

Once you reach the annual limit, Medicare stops paying. You can continue therapy, but you pay the full cost unless your doctor successfully requests a manual medical review exception. Some therapists offer reduced rates for patients who have exhausted their Medicare benefit, but you should ask directly rather than assume.

Does Medicare cover therapy for arthritis or chronic pain?

Yes, if a doctor orders it. Physical therapy for arthritis or occupational therapy to help you manage chronic pain is covered when the doctor documents that it is medically necessary and will improve your function. Therapy for general wellness or pain management without a specific medical diagnosis is not covered.

Can I choose any therapist, or do they have to be in-network?

You can see any therapist who accepts Medicare, whether they are in-network or not. However, if the therapist does not accept Medicare assignment, you may owe more than 20 percent coinsurance. In-network therapists agree to accept Medicare's approved amount, which limits your cost.

If I am in a skilled nursing facility after surgery, do I pay for therapy?

No. Therapy in a skilled nursing facility is covered under Medicare Part A (your hospital benefit) with no separate charge, as long as you were admitted to the SNF within three days of a hospital stay and are still within your benefit period. This therapy does not count toward your Part B annual limit.

Does Medicare cover mental health counseling or therapy?

Yes, but it is different from physical or occupational therapy. Medicare Part B covers outpatient mental health services, including individual therapy with a licensed therapist, at 80 percent of the approved amount after your deductible. There is no annual limit for mental health services, but there are other rules about frequency and provider type.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.