Medicare covers physical therapy, but only under specific conditions and with limits on how many visits you can have

Medicare Part B pays for physical therapy when a doctor orders it to treat a medical condition — not for general fitness or wellness. The program covers the therapist's fee at 80 percent after you meet your annual deductible. You pay the remaining 20 percent, plus the full cost of any visits beyond the yearly limit. The yearly limit is 60 visits for physical therapy alone, though you may be able to request more if your doctor documents medical necessity.

The catch is that Medicare requires the therapy to be medically necessary — meaning it must treat a specific injury, illness, or condition that a doctor has documented. Therapy for arthritis, stroke recovery, or a knee replacement qualifies. Therapy to stay active or prevent future problems does not. You also must receive the therapy from a Medicare-enrolled provider, and the provider must submit the claim themselves rather than billing you upfront.

Key Takeaways

  • Medicare Part B covers 80 percent of physical therapy costs after you pay your annual deductible, and you pay 20 percent of each visit.
  • You have a yearly limit of 60 visits for physical therapy alone, though your doctor can request more if the medical need is documented.
  • A doctor must order the therapy and document that it treats a specific medical condition, not general fitness or prevention.
  • The therapist must be enrolled with Medicare and bill the program directly; if they bill you upfront, the visit may not count toward your limit.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20 percent.

How the 60-visit yearly limit works

The 60-visit limit applies to physical therapy visits in a calendar year, whether you receive them in an outpatient clinic, your home, or a hospital outpatient department. Each visit counts as one visit, regardless of how long the session lasts. Once you reach 60 visits, Medicare stops paying, and you become responsible for the full cost of any additional visits unless your doctor has filed a request for more visits based on medical necessity.

The request for additional visits is called a therapy cap exception. Your doctor or therapist can submit this to Medicare before you hit 60 visits, explaining why you need more. Medicare reviews the request and either approves more visits or denies it. The process takes time — sometimes two to four weeks — so if you are approaching your limit, ask your therapist to file the exception early rather than waiting until you have used all 60.

The 60-visit limit resets on January 1 each year. If you used 50 visits in 2024, you start 2025 with a fresh 60-visit allowance. Some people plan their therapy schedule around this calendar to avoid running out of coverage mid-treatment.

What you pay out of pocket

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. The Part B deductible is a fixed amount you pay before Medicare begins to pay its share. Once you have paid the deductible, Medicare covers 80 percent of the approved amount for physical therapy, and you pay 20 percent.

The approved amount is what Medicare decides the visit is worth, not necessarily what the therapist charges. If a therapist charges $150 per visit but Medicare's approved amount is $100, your 20 percent is $20, not $30. The therapist is required to accept Medicare's approved amount as payment in full and cannot bill you for the difference.

If you have not met your Part B deductible yet, you pay the full cost of each visit until the deductible is satisfied. After that, the 20 percent coinsurance kicks in. Your deductible resets on January 1 each year, so costs can be higher in January and February than later in the year.

Medigap and Medicare Advantage plans may lower your costs

If you have a Medigap policy (supplemental insurance), it may cover some or all of the 20 percent coinsurance you would otherwise pay. Medigap Plan G and Plan N, for example, cover the Part B coinsurance, so you would pay nothing per visit after your deductible. Other Medigap plans cover part of the coinsurance. Check your policy documents or call your Medigap insurer to see what physical therapy costs they cover.

If you have a Medicare Advantage plan, your out-of-pocket cost depends on your plan's design. Some Advantage plans charge a copay per visit (for example, $25 per visit) instead of 20 percent coinsurance. Others charge coinsurance. Advantage plans also set their own visit limits, which may be higher or lower than the standard 60 visits. Review your plan's summary of benefits or call the plan to find out what you will pay for physical therapy.

Where to receive physical therapy and stay in-network

Medicare covers physical therapy in several settings: an outpatient clinic, a hospital outpatient department, your home (if you are homebound), or a skilled nursing facility (if you are recovering from a hospital stay). The setting does not change the 60-visit limit or your cost-sharing — it is the same 80/20 split after your deductible.

To may support Medicare pays, the provider must be enrolled with Medicare. Before your first visit, ask the clinic or therapist whether they accept Medicare and whether they are enrolled. If they are not enrolled, Medicare will not pay, and you will be responsible for the full bill. Some therapists are enrolled but only for certain settings (for example, enrolled for clinic visits but not home visits), so confirm the specific location where you plan to receive care.

If you receive therapy from a non-enrolled provider, you can still file a claim yourself, but Medicare will likely deny it, and you will have no recourse. It is much simpler to use an enrolled provider from the start.

How to get your doctor's order and start therapy

Physical therapy must be ordered by a doctor — either your primary care physician, a specialist, or a hospital discharge planner. The order should specify the condition being treated (for example, "post-op knee replacement" or "stroke recovery") and the type of therapy needed. Without a doctor's order, Medicare will not pay, even if you pay out of pocket and try to get reimbursed later.

Once you have the order, contact a physical therapy clinic or your local hospital's outpatient therapy department and ask whether they accept Medicare. Provide them with your Medicare card and the doctor's order. They will verify your coverage, confirm your deductible status, and tell you what your cost per visit will be. They will also schedule your first appointment and handle billing to Medicare directly.

If your doctor has not ordered therapy but you think you need it, ask your doctor at your next visit. Explain what is limiting you physically, and ask whether physical therapy might help. If your doctor agrees, they can write the order on the spot or send it electronically to a therapy provider you choose.

What happens if you run out of visits or coverage ends

If you reach 60 visits and your doctor has not filed a therapy cap exception, or if the exception was denied, Medicare stops paying. At that point, you have three options: stop therapy, pay out of pocket for additional visits, or ask your doctor to file another exception request with new clinical information.

Some people continue therapy and pay the full cost themselves. Others pause therapy and resume later in the year or the following year when they have a fresh 60-visit allowance. A few work with their therapist and doctor to file a second exception request if their condition has changed or they have made progress that justifies more visits.

If you are in a Medicare Advantage plan and your plan's visit limit is lower than 60, the same logic applies — once you hit your plan's limit, Medicare stops paying unless your doctor files an exception and it is approved.

Frequently Asked Questions

Does Medicare cover physical therapy for arthritis or just after surgery?

Medicare covers physical therapy for arthritis if a doctor orders it to treat pain, stiffness, or loss of function caused by the arthritis. It also covers therapy after surgery, for stroke recovery, for balance problems, and for many other conditions. The key is that a doctor must document that the therapy treats a specific medical condition, not that you want to stay active or prevent future problems.

What if my physical therapist is not enrolled with Medicare?

If your therapist is not enrolled, Medicare will not pay for your visits. You can ask the therapist to enroll, but that process takes time. It is faster to find an enrolled provider. You can search for Medicare-enrolled physical therapists on Medicare.gov or call your local hospital's outpatient therapy department, which is always enrolled.

Can I get more than 60 visits if my doctor says I need them?

Yes, your doctor or therapist can request a therapy cap exception before you reach 60 visits. Medicare reviews the request and decides whether the medical need justifies more visits. The request must include clinical notes showing your progress and why continued therapy is necessary. Approval is not may provide, but the exception process exists for cases where 60 visits is not enough.

Do I have to pay my deductible every year for physical therapy?

Yes, your Part B deductible resets on January 1 each year. If you start physical therapy in January, you pay the full deductible before Medicare begins to pay its 80 percent share. If you start therapy later in the year after you have already met your deductible for other services, you do not pay it again for physical therapy.

Will my Medicare Advantage plan cover the same amount as Original Medicare?

No, Medicare Advantage plans set their own rules. Some cover more than 60 visits per year, some cover fewer, and some charge a copay instead of coinsurance. Check your plan's summary of benefits or call the plan directly to find out what physical therapy coverage you have.