Medicare covers physical therapy, but only if a doctor orders it and you meet specific conditions

Medicare Part B pays for physical therapy when a doctor refers you for treatment of an injury, illness, or surgery recovery. The therapy must be medically necessary — meaning it treats a specific condition rather than general wellness or fitness. Medicare will cover the sessions themselves, but you pay a share of the cost through your deductible and copayment.

The catch is that Medicare limits how many visits you can have per year and requires that your condition show measurable improvement. If your therapist cannot document that you are getting better, Medicare may stop paying. You also cannot straightforward walk into a physical therapy clinic; a physician must refer you first.

Key Takeaways

  • Your doctor must refer you to physical therapy for Medicare to cover it; you cannot self-refer or go directly to a clinic.
  • Medicare Part B covers the therapy sessions after you meet your annual deductible, then you pay a 20% copayment for each visit.
  • Medicare sets an annual cap on how much it will spend on physical therapy combined with occupational therapy, though the exact amount changes year to year.
  • Your therapist must show that your condition is improving; if progress stops, Medicare may deny further sessions even if your doctor wants to continue.
  • Outpatient therapy in a clinic or your home is covered, but therapy in a hospital or skilled nursing facility follows different rules.

How the referral and approval process works

Start by seeing your primary care doctor or the specialist treating your condition. Tell them you need physical therapy and why — for example, recovering from knee surgery, regaining strength after a stroke, or managing arthritis pain. The doctor writes an order that includes the diagnosis, the type of therapy needed, and how many sessions they think you will need.

You then take this referral to an outpatient physical therapy clinic or arrange for a home visit. The clinic submits the referral to Medicare along with your medical records. Medicare reviews it to confirm the therapy is medically necessary for your condition. This review usually takes a few days to a week. If Medicare approves it, you can start therapy. If they deny it, your doctor can appeal or you can ask for a second opinion from another physician.

Some clinics will tell you upfront whether they think Medicare will cover your case based on your diagnosis and medical history. This is not a may provide, but it can help you understand what to expect.

What you pay out of pocket

Medicare Part B covers 80% of the cost of physical therapy after you have met your annual deductible. In 2024, the Part B deductible is $240, but this amount changes each year. Once you reach that deductible through any Part B services — doctor visits, lab work, therapy, or other covered care — Medicare begins paying its 80% share.

You pay the remaining 20% of each therapy session. The actual cost varies by location and clinic, but a typical physical therapy session costs between $100 and $200 before insurance. Your 20% copayment would be $20 to $40 per visit. If you have a Medigap or Medicare Advantage plan, that plan may cover some or all of your copayment, so check your plan documents.

Keep in mind that the therapy cost counts toward Medicare's annual spending limit. Once you and Medicare together have spent a certain amount on physical therapy and occupational therapy combined in a calendar year, Medicare stops paying. Your doctor can request an exception if your condition requires more therapy, but this requires extra paperwork and is not always approved.

The annual visit limit and progress requirements

Medicare does not publish a straightforward number like "you get 30 visits per year." Instead, Medicare sets a dollar cap on combined physical therapy and occupational therapy spending. The cap changes annually and is adjusted for inflation. When the total spending reaches that cap, Medicare stops covering new sessions unless your doctor requests and receives an exception.

Beyond the spending cap, Medicare requires that your therapy show measurable progress toward a specific goal. Your therapist documents your strength, range of motion, pain level, and ability to perform daily tasks at the start and regularly throughout treatment. If the notes show you are improving, therapy continues. If progress plateaus or declines, Medicare may deny further sessions even if your doctor wants to keep treating you.

This means therapy for chronic pain management alone — where the goal is to maintain function rather than improve it — may not be covered long-term. Therapy aimed at recovery from surgery, injury, or acute illness is more likely to show the measurable progress Medicare requires.

Physical therapy in different settings

Outpatient therapy at a clinic or in your home is the most straightforward path. Medicare covers both equally, though home therapy may have slightly different scheduling or documentation requirements. If you cannot leave your home due to illness or disability, your doctor can order home-based physical therapy and Medicare will cover it the same way.

If you are in a hospital or skilled nursing facility after surgery or a serious illness, physical therapy is usually included in your facility stay and billed differently — not through Part B. Once you are discharged and return home, you switch to outpatient therapy if you need to continue, and the Part B rules explore from that point forward.

Therapy in a hospital outpatient department or ambulatory surgery center follows the same Part B coverage rules as a private clinic. The setting does not change your deductible, copayment, or visit limits.

What conditions Medicare typically covers

Medicare covers physical therapy for recovery from surgery, such as knee replacement, hip replacement, or rotator cuff repair. Therapy after a stroke, heart attack, or other serious illness is covered. Treatment for fractures, sprains, and other injuries is covered. Therapy to manage arthritis pain and improve mobility, therapy for balance problems and fall prevention, and therapy to regain strength after a period of immobility are all covered.

Therapy for chronic conditions where the goal is maintenance rather than improvement — such as ongoing management of stable arthritis with no new injury — may not be covered long-term because it does not meet the "improvement" requirement. Therapy purely for fitness, wellness, or athletic performance is not covered. Therapy for conditions that are not improving despite treatment may be denied after a certain number of visits.

Questions to ask your doctor before starting therapy

Ask your doctor whether they think your condition will show measurable improvement with therapy, because Medicare requires this. Ask how many sessions they are ordering and why that number. Ask whether they have seen Medicare deny therapy for your type of condition, and if so, what they did to appeal. Ask whether your therapy might hit Medicare's annual spending limit before you reach your goal, and what the plan would be if that happens.

Ask your therapist to explain how they will measure your progress and how often they will report it to Medicare. Ask what happens if Medicare denies a session or stops covering your care partway through. Ask whether your Medigap or Medicare Advantage plan covers any of your copayments. These conversations upfront can prevent surprises later.

When to contact Medicare or appeal a denial

If Medicare denies your physical therapy referral, you have the right to appeal. Your doctor can file an appeal on your behalf, usually by submitting additional medical records or a letter explaining why the therapy is necessary. Appeals can take several weeks, so ask your doctor to file as soon as you receive a denial.

If Medicare stops covering your therapy because you have hit the annual spending limit, your doctor can request an exception by submitting a detailed note about your condition and why continued therapy is medically necessary. This is called a "therapy cap exception" and is not automatic, but it is worth requesting if your doctor believes you need more treatment.

Contact Medicare directly at 1-800-MEDICARE if you have questions about your coverage or want to check the status of an appeal. You can also contact your State Health Insurance information Program (SHIP), which offers free counseling about Medicare coverage questions.

Frequently Asked Questions

Do I need a referral from my primary care doctor, or can any doctor order physical therapy?

Any doctor can order physical therapy — your primary care doctor, a specialist, or even a doctor you see in an urgent care clinic. The doctor must be part of Medicare's network and must document that the therapy is medically necessary for your condition. The referral goes to Medicare for approval before you start.

What if I want to continue physical therapy after Medicare stops covering it?

You can pay out of pocket for additional sessions, though the cost is typically $100 to $200 per visit without insurance. Some clinics offer discounted rates for self-pay patients. You can also ask your doctor whether therapy could be covered under a different diagnosis or whether a break in treatment followed by a new referral might reset your visit count, though this depends on your specific situation.

Does Medicare Advantage cover physical therapy differently than Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but many plans offer additional physical therapy visits or lower copayments. Check your plan's coverage documents or call the plan directly to see what your specific benefits are. Some Advantage plans do not require a referral or may have different approval processes.

Can I get physical therapy at home if I cannot travel to a clinic?

Yes. Your doctor can order home-based physical therapy and Medicare will cover it under the same rules as outpatient clinic therapy — after your deductible, you pay 20% of the cost. The therapist must be part of a Medicare-approved agency, and your home must be your primary residence. Medicare will not cover therapy at a vacation home or temporary location.

What happens if my therapist says I need more visits but Medicare says I have reached my limit?

Your therapist or doctor can request a therapy cap exception from Medicare by submitting documentation that continued therapy is medically necessary and that you are still showing progress. This requires extra paperwork and takes time, but it is not automatically denied. If the exception is denied, you can appeal or pay out of pocket for additional sessions.