Yes. Medicare covers medically necessary treatment, so your physical therapy will be covered under Part A or Part B, depending on where you receive the treatment. You do not need a referral to get physical therapy, but Medicare will only cover services from approved providers.
Medicare Covers Physical Therapy
Medicare Part A will cover physical therapy you receive as an inpatient, during home health care, or at a skilled nursing facility. Often patients will be evaluated by a physical therapist while they are an inpatient in the hospital, if there is a chance they will need rehabilitation. Those services rendered while you are an inpatient will be billed to Medicare Part A.
Medicare Part B covers outpatient physical therapy services that are approved and certified by your doctor or physical therapist. Occupational therapy can be included in this coverage, and you may be able to receive coverage for outpatient care provided at your home or at an outpatient facility or skilled nursing facility. When you go to a dedicated physical therapy center, this will be considered outpatient treatment.
Your Medicare Advantage plan will offer the same coverage as Original Medicare under Part A and Part B care. If you have a Medicare Supplement, you may get help covering some of the expenses of Part A and Part B associated with your physical therapy treatment.
Limits to Physical Therapy Coverage Under Medicare
There is no need to worry about a cap on physical therapy coverage with Medicare. You can receive as many physical therapy treatments within one calendar year as you need, provided your doctor or physical therapist certifies that the treatment is medically necessary.
What You Pay for Physical Therapy
If you receive physical therapy as part of inpatient care or home health care, your coverage comes through Medicare Part A. The costs for Part A include a deductible of $1,556 per benefit period and daily coinsurance after day 60 within each benefit period. A benefit period counts the time between being admitted as an inpatient and when you have not received inpatient care for 60 days.
Your costs under Medicare Part B are 20% of the Medicare-approved amount once you have met the Part B deductible of $233. Even if you have a Medicare Advantage plan, you will still be asked to pay this 20% as coinsurance or copayment.
For help understanding your coverage and to find the Medicare plan that makes the most sense for you, speak with a representative at Magellan Healthcare. Our team of dedicated experts is here to help.
