Does Medicare Cover Physical Therapy? — the Straight Answer

Yes. Medicare Part B covers medically necessary outpatient physical therapy ordered under a treatment plan, with no yearly dollar cap. You pay 20% of the Medicare-approved amount after the Part B deductible.

What Original Medicare covers

Medicare Part B covers outpatient physical therapy when it's medically necessary and delivered under a plan of care your doctor or therapist sets up and reviews regularly. That includes therapy in a private practice, a hospital outpatient department, a rehab facility, or sometimes at home. Physical therapy is also covered in other settings under different rules: during an inpatient hospital or skilled nursing facility stay under Part A, and through the home health benefit if you qualify as homebound.

Two things surprise people, in a good way. First, there is no longer a yearly dollar cap on outpatient therapy — Congress removed the old "therapy cap" in 2018. Above a certain yearly amount your therapist must document that continued care is still medically necessary, but there is no fixed cutoff. Second, you don't have to be improving: skilled therapy to maintain your condition or slow decline can qualify, as long as the care genuinely requires a therapist's skill.

What it does not cover

Services that aren't medically necessary: general fitness and wellness programs, gym memberships, and continued sessions once you could safely do the exercises on your own. When a therapist expects Medicare to deny further visits, you should get an Advance Beneficiary Notice before continuing, so nothing surprises you on a bill.

What it costs

After the $283 annual Part B deductible, you pay 20% of the Medicare-approved amount for each session — and a long course of therapy adds up at 20% per visit. A Medigap policy typically picks up that share. Medicare Advantage plans cover the same therapy benefit but may apply their own copays and require prior authorization or in-network therapists.

Who to ask

Talk to your doctor about whether physical therapy fits your condition, and ask your therapist how many visits the plan of care calls for and what happens if you need more. Talk to a licensed advisor if open-ended 20% coinsurance is the kind of cost you'd rather see capped — that trade-off is exactly what the different coverage arrangements differ on.