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Medicare and Physical Therapy

Physical therapy forms an integral part of the treatment of several diseases including stroke, injuries, fractures, and so on. Your doctor may recommend physical therapy to help you recover faster and improve your mobility.

A physical therapist can also help to restore normal physical functions related to your muscles, joints, and bones. This would help to prevent impairments, functional limitations, and disabilities resulting from accidents, injuries, and other conditions.

If your doctor has advised physical therapy, you must be wondering whether Medicare covers physical therapy costs. Read this article to find all about the coverage of physical therapy by Medicare Plans.

physical therapy session

What are physical therapy benefits covered by Medicare?

Generally, Medicare covers the cost of physical therapy services that are considered medically essential for the patient to recover. The benefits would also include the coverage for other medically essential therapies like speech-language therapy and occupational therapy.

Your doctor may recommend different types of physical therapies depending on your specific ailment. Medicare coverage for these therapies would depend on where you receive services.

Medicare Part B usually covers physical therapy. If you receive physical therapy at a hospital, in the registered physician’s office or an outpatient center, 80% of allowable charges would be covered by Medicare Part B. However, to be eligible for this coverage, you must have met your Part B deductible.

If you plan to receive physical therapy at home, the Medicare Part A and Part B would cover the entire costs related to the allowable inclusions. In order to receive 100% coverage for the Medicare physical therapy received at home, you must meet the following conditions:

  • You need to be certified homebound by the physician.
  • You must be under the care of a physician, and the physical therapy must be a part of a comprehensive care plan regularly reviewed by the doctor.
  • Physical therapy must be performed by a qualified therapist.
  • The agency providing home healthcare services must be certified by Medicare.
  • Your physician believes that the condition you are diagnosed with is expected to improve with the physical therapy considerably, or physical therapy is needed to maintain your health and prevent it from worsening.

It should be noted that home care physical therapy services are not covered by Medicare when they are intermittent or part-time in nature.

If qualified for physical therapy at home, you need to pay only 20% of the costs related to any medical equipment recommended by your physician as a part of the treatment.

Additional information

Though there is no specific limit on the amount of coverage for physical therapy in a given calendar year, your physician may have to provide extra information when the costs exceed a certain amount.

Your doctor will need to specify why the services are medically necessary for Medicare to continue to cover the costs.

Also, if you have a Medicare Advantage plan, you might receive extra coverage in addition to those covered under Part A and Part B of Medicare.

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