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

Medicare Part B pays for physical therapy when a doctor orders it to treat a medical condition — not for general fitness or wellness. The therapy must take place in an outpatient setting: a hospital outpatient department, a rehabilitation facility, your home, or a therapist's private office. Medicare will not pay for therapy you arrange on your own without a doctor's referral, and it will not cover therapy at a gym or fitness center, even if a therapist works there.

You pay 20 percent of the Medicare-approved amount for each visit after you meet your Part B deductible for the year. The therapist's office bills Medicare first, and Medicare sends you a bill for your share. If the therapist charges more than Medicare's approved amount, you may owe the difference — unless the therapist has agreed to accept Medicare's rate as payment in full.

Key Takeaways

  • A doctor must order physical therapy for a medical condition; Medicare does not cover therapy you start on your own.
  • You pay 20 percent of the Medicare-approved cost per visit after meeting your Part B deductible, which resets each January.
  • Medicare sets an annual limit on therapy visits, though your doctor can request an exception if medically necessary.
  • Home-based therapy is covered if a doctor orders it and you are homebound or have difficulty leaving home.
  • You should ask the therapist's office to verify your coverage before your first visit, because coverage rules change and vary by setting.

How the referral and ordering process works

Your primary care doctor, a specialist, or a hospital discharge planner must write an order for physical therapy. The order should state the medical reason — for example, recovery after knee surgery, stroke rehabilitation, or treatment for a chronic condition like arthritis. Without this order, Medicare will not pay, and you will owe the full cost of each visit.

When you call a physical therapy office to schedule, tell them you have a Medicare referral. Ask them to contact your doctor's office to confirm the order before your first appointment. Some offices do this automatically; others wait for you to provide the doctor's contact information. If the order is missing or incomplete, the therapist's office will ask your doctor to send it. This step can add a week or more to your start date, so following up yourself speeds things up.

The therapist will evaluate you at your first visit and may adjust the treatment plan based on what they find. Medicare requires the therapist to document that the therapy is medically necessary and that you are making progress. If you stop making progress, Medicare may stop paying even if your doctor's original order is still active.

Understanding visit limits and annual caps

Medicare sets an annual limit on the number of therapy visits it will pay for in a calendar year. The limit applies to physical therapy, occupational therapy, and speech-language pathology combined — not separately. This means if you use some visits for physical therapy and some for occupational therapy, they count toward the same total.

The annual limit changes year to year and depends on how much therapy costs in your region. Your therapist's office should tell you the current limit when you call to schedule. Ask them to confirm the limit in writing so you know how many visits Medicare will cover before you reach it.

If your doctor believes you need more visits than the limit allows, they can request an exception from Medicare. This is called a therapy cap exception. The request must include medical documentation showing why additional therapy is necessary. Medicare reviews the request and approves or denies it within a set timeframe. Even if Medicare denies the exception, you can continue therapy and pay out of pocket, or you can appeal the denial.

What you pay at each visit

After you meet your Part B deductible for the year, you pay 20 percent of the Medicare-approved amount for each physical therapy visit. The deductible resets on January 1 each year. If you have not met your deductible yet, you pay the full cost of therapy until you do, then you pay 20 percent for the rest of the year.

The Medicare-approved amount is not the same as what the therapist charges. Medicare sets its own rate for each service code, and therapists must accept that rate or decline to treat Medicare patients. If a therapist is out of network and does not accept Medicare assignment, you may owe more. Before your first visit, ask the office whether they accept Medicare assignment and what your out-of-pocket cost will be per visit.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your 20 percent share. Check your plan documents or call your plan's customer service line to find out what physical therapy costs you under your specific plan.

Physical therapy in your home

Medicare covers home-based physical therapy if a doctor orders it and you meet one of two conditions: you are homebound, or you have a medical condition that makes it difficult or unsafe to leave home. Homebound means you cannot leave without help from another person or medical equipment, or leaving would be medically contraindicated — meaning your doctor has advised against it.

Home therapy is billed the same way as office-based therapy: you pay 20 percent of the Medicare-approved amount after your deductible. The therapist must be employed by or contracted with a Medicare-certified home health agency. You cannot hire a therapist directly and have Medicare pay; the agency handles billing and documentation.

Home therapy visits count toward your annual visit limit, just as office visits do. If you are receiving other home health services — nursing, occupational therapy, or speech therapy — those visits also count toward the same combined limit.

Coverage after hospitalization or skilled nursing

If you were hospitalized or stayed in a skilled nursing facility and your doctor orders physical therapy as part of your discharge plan, Medicare Part B covers outpatient therapy once you leave. The therapy must start within a reasonable time after discharge — usually within a few weeks. If you wait months to start therapy, Medicare may question whether it is still medically necessary for your condition.

Some people continue therapy at a rehabilitation facility instead of going home. If the facility is Medicare-certified and your doctor orders continued therapy, Medicare Part B covers it. You pay 20 percent of the approved amount per visit, the same as outpatient therapy. The facility's billing office should explain your costs before you are discharged from the hospital or nursing home.

What Medicare does not cover

Medicare does not pay for physical therapy ordered for general fitness, wellness, or prevention — even if a therapist recommends it. Therapy for a chronic condition you already have is covered, but therapy to prevent a condition you do not yet have is not. For example, therapy after a stroke is covered; therapy to prevent a future stroke is not.

Medicare does not cover therapy at a gym, fitness center, or wellness facility, even if a licensed therapist works there. If you want therapy in that setting, you pay the full cost yourself. Some Medicare Advantage plans offer supplemental fitness benefits, so check your plan documents if you are interested in gym-based programs.

Therapy ordered by a therapist without a doctor's referral is not covered. Some therapists can evaluate you and recommend therapy, but Medicare requires a physician's order before payment begins. If you see a therapist for an evaluation and then want to proceed, ask them to send a report to your doctor requesting an order.

How to verify coverage before you start

Before your first appointment, call the physical therapy office and ask them to verify your Medicare coverage. Provide your Medicare number and the date of your doctor's referral. The office should tell you whether Medicare will pay, what your deductible status is, how many visits are available under the annual limit, and what you will owe per visit.

Ask the office to send you a written estimate of your out-of-pocket costs. This estimate should include your deductible responsibility, your 20 percent coinsurance per visit, and the number of visits Medicare is expected to cover. If the estimate seems high or unclear, ask for clarification before you start therapy.

If you have a supplemental plan or Medicare Advantage plan, also call that plan's customer service line and ask what physical therapy costs under your specific coverage. Plans vary widely, and your plan may cover more than Original Medicare does.

Frequently Asked Questions

Can I get physical therapy without a doctor's order?

No. Medicare requires a physician's order for physical therapy to be covered. If you see a therapist without a referral, you pay the full cost. Some states allow physical therapists to evaluate you without a referral, but Medicare will not pay for that evaluation or any therapy that follows unless a doctor then writes an order.

What happens if I run out of visits before the year ends?

Once you reach the annual visit limit, Medicare stops paying. You can continue therapy and pay out of pocket, or your doctor can request an exception from Medicare if the therapy is medically necessary. If Medicare denies the exception, you can appeal or stop therapy.

Do I pay the same amount at every visit?

You pay 20 percent of the Medicare-approved amount at each visit after your deductible is met. The approved amount may vary slightly depending on the specific therapy code billed, so your cost per visit could be slightly different. Ask your therapist's office for an itemized bill so you can see what Medicare approves for each visit.

Is physical therapy covered if I have a Medicare Advantage plan?

Yes, but the coverage rules and your costs may be different from Original Medicare. Medicare Advantage plans must cover at least what Original Medicare covers, but many offer additional benefits or lower coinsurance. Check your plan documents or call your plan to find out your specific coverage and costs.

Can I choose any physical therapist, or do I have to use one in a network?

With Original Medicare, you can see any therapist who accepts Medicare assignment. With a Medicare Advantage plan, you usually must use a therapist in your plan's network, or you pay more. Check your plan's provider directory or call customer service to find in-network therapists near you.