Medicare pays 80 percent of physical therapy costs after you meet your Part B deductible, but the amount depends on where you receive treatment and whether your therapist is in the Medicare network.

Medicare Part B covers physical therapy when a doctor orders it for a medical condition — not for general fitness or wellness. The program pays its share directly to the therapist or facility. You pay the remaining 20 percent of the Medicare-approved amount, which is the price Medicare has set for that service in your area. If your therapist does not accept Medicare assignment (meaning they do not agree to accept Medicare's approved amount as full payment), you could owe more.

The actual dollar amount Medicare pays varies by location and by the specific service code the therapist uses. A single physical therapy session in one state might have a different Medicare-approved amount than the same session in another state. This is why two people receiving identical treatment can have different out-of-pocket costs.

Key Takeaways

  • Medicare Part B covers physical therapy ordered by a doctor for a medical condition, and Medicare pays 80 percent after you meet your annual deductible.
  • You pay 20 percent of the Medicare-approved amount for each session, which varies by your location and the type of service provided.
  • Physical therapy must be medically necessary — treatment for an injury, surgery recovery, or chronic condition — not preventive or fitness-focused.
  • Outpatient physical therapy in a clinic, hospital, or your home is covered, but the setting affects which Medicare rules explore.
  • If your therapist does not accept Medicare assignment, you may owe more than the standard 20 percent coinsurance.

How the 80/20 split works in practice

When you receive physical therapy covered by Medicare Part B, the program does not pay a flat rate per session. Instead, Medicare assigns a code to each service — for example, a 30-minute evaluation session has a different code than a 15-minute follow-up treatment. Each code has a Medicare-approved amount set by region.

Let's say the Medicare-approved amount for a particular therapy session in your area is $100. Medicare pays $80 (80 percent), and you pay $20 (20 percent) as coinsurance. But this only happens after you have paid your Part B deductible for the year — in 2024, that deductible is $240, though this amount changes annually. Until you reach that deductible, you pay the full approved amount yourself.

Once you have met your deductible, the 80/20 split applies to all covered physical therapy for the rest of that calendar year. The coinsurance resets on January 1.

Where you receive therapy affects your costs

Physical therapy covered by Medicare can happen in three main settings: an outpatient clinic, a hospital outpatient department, or your home. The setting matters because it changes how Medicare calculates what it pays and what you owe.

In an outpatient clinic or private practice, the therapist bills Medicare Part B directly. You pay the 20 percent coinsurance after your deductible. In a hospital outpatient department, you may owe a copayment instead of coinsurance — the amount varies but is often higher than 20 percent of the approved amount. Home health physical therapy is covered under Part B if a doctor orders it and you are homebound, and the payment rules are similar to outpatient clinic care.

Before starting therapy, ask your provider whether they are billing as an outpatient clinic or a hospital department. This tells you whether to expect coinsurance or a copayment and helps you estimate your costs.

When Medicare will and will not cover physical therapy

Medicare covers physical therapy when a licensed physician, nurse practitioner, or physician assistant orders it for a medical condition. Common reasons include recovery from surgery, stroke rehabilitation, arthritis management, balance problems that increase fall risk, and weakness from hospitalization or illness.

Medicare does not cover physical therapy for general fitness, wellness, or prevention — even if your doctor recommends exercise for your health. The therapy must treat a specific medical problem. If you are recovering from a hip replacement, therapy is covered. If you want to improve your strength to prevent falls, it is not, unless you have already had a fall or have a documented balance disorder.

Your therapist and doctor determine whether your condition meets Medicare's medical necessity standard. If Medicare denies a claim, you have the right to appeal, and your provider can help you understand why the denial happened.

What happens if your therapist does not accept Medicare assignment

Most physical therapists and clinics accept Medicare assignment, meaning they agree to accept Medicare's approved amount as full payment (after you pay your 20 percent coinsurance). But some do not. If your therapist is a non-participating provider, they can charge you more than the approved amount.

A non-participating therapist can charge up to 15 percent above Medicare's approved amount. If the approved amount is $100, they can charge you up to $115. You would then owe 20 percent of that higher amount, not 20 percent of $100. This adds up quickly over multiple sessions.

Before your first appointment, ask whether the therapist accepts Medicare assignment. If they do not, ask what their actual fee is and calculate what your 20 percent coinsurance will be. You can then decide whether to continue with that provider or find one who accepts assignment.

Supplemental insurance and other coverage

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 20 percent coinsurance for physical therapy. The coverage depends on which Medigap plan you have — Plans C, D, G, and M cover coinsurance, while other plans do not. Check your plan documents or call your insurer to confirm.

If you have Medicare Advantage (Part C) instead of Original Medicare, your physical therapy coverage and costs work differently. Medicare Advantage plans must cover at least as much as Original Medicare, but they set their own copayments and coinsurance amounts. Some plans cover more sessions or charge less per visit. Review your plan's summary of benefits or call the plan to learn your specific costs.

Veterans, Medicaid recipients, and people with other insurance should check whether that coverage pays first or whether Medicare is primary. Coordination of benefits affects what you ultimately owe.

How to find out what you will actually pay

The only way to know your exact out-of-pocket cost is to contact the physical therapy provider and ask three things: Do they accept Medicare assignment? What is the Medicare-approved amount for the services you need in your area? And what is your coinsurance or copayment?

You can also call Medicare directly at 1-800-MEDICARE to ask what the approved amount is for a specific service code in your zip code. Medicare's website has a tool called the Physician Fee Schedule Lookup that shows approved amounts by location and service type, though it requires some familiarity with procedure codes.

If cost is a concern, ask your doctor or therapist whether the same treatment is available at a lower cost in a different setting — for example, an outpatient clinic instead of a hospital department. Some communities also have sliding-scale physical therapy clinics or programs through senior centers that charge based on income.

Frequently Asked Questions

Does Medicare cover unlimited physical therapy sessions?

No. Medicare Part B has an annual cap on therapy services. The cap applies to physical therapy, occupational therapy, and speech-language pathology combined. The cap amount changes yearly — in 2024 it is $2,210. However, your doctor can request an exception if medically necessary, and Medicare may approve therapy beyond the cap.

What if I go to physical therapy before my doctor orders it?

Medicare will not pay for sessions that happen before a doctor has ordered therapy. You will owe the full cost. Always get a doctor's order in writing before your first appointment so Medicare knows the therapy is medically necessary.

Do I have to pay the deductible every year?

Yes. Medicare's Part B deductible resets on January 1 each year. Any physical therapy you receive before meeting that year's deductible is paid entirely by you. Once you meet it, Medicare begins paying its 80 percent share for the rest of that calendar year.

Can I use my HSA or FSA to pay for physical therapy coinsurance?

Yes. If you have a Health Savings Account or Flexible Spending Account, you can use those funds to pay your 20 percent coinsurance for Medicare-covered physical therapy. Keep your receipts and explanation of benefits statements for tax purposes.

What if my therapist charges more than Medicare's approved amount?

If your therapist accepts Medicare assignment, they cannot charge you more than your 20 percent coinsurance. If they do not accept assignment, they can charge up to 15 percent above the approved amount. Always confirm assignment status before treatment begins.