Does Medicare Cover Physical Therapy?
For one reason or the other, you may find yourself in need of physical therapy and in that moment, you may wonder if your Medicare plan will cover the same.
Physical therapy offers a variety of treatment options and although Medicare covers physical therapy under certain circumstances, you might be responsible for paying for services in full.
In this article, we seek to find out if Medicare covers physical therapy so you may want to stick around.
Which Parts of Medicare Cover Physical Therapy?
Physical therapy is covered by Medicare only if it is part of a related service such as a fracture rehabilitation program and authorized by your doctor.
Physical therapy that is not part of an approved Medicare-covered program will not be paid for, and you may be responsible for the total cost.
Further, if you received physical therapy before your doctor authorized its use, you may owe refunds or penalties depending on the amount and length of services received.
Medicare, United States’ national health insurance program, covers physical therapy as a medical service. To qualify for Medicare physical therapy benefits, you must be a member of the United States’ public health program.
Persons residing in the United States who cannot work due to injury by illness or those experiencing medical complications may qualify for Medicare.
Funds allocated for Medicare physical therapy services are managed by a private insurance company contracted by the federal government.
How Much Does Physical Therapy Cost?
To learn if your Medicare coverage includes physical therapy and, if not, how you can obtain coverage and what your out-of-pocket cost may be, please consult with your physician and ask for a referral to a physical therapist.
That said, physical therapy costs vary across the nation. For example, the average price of a physical therapist in Manhattan can range from $60-$80 per session, or roughly 312-420 per hour.
However, this can vary significantly based on your location and the type of therapist you opt for. The most expensive cities are those in which high demand increases the price.
New York City and Los Angeles are prime examples, but more rural areas tend to have lower costs due to fewer therapists and lower demand.
Restrictions and Limitations
Physicians or physical therapists often oversee the development of a treatment plan for patients receiving physical therapy.
To be covered by Medicare, the plan must address why the patient is receiving PT and how the therapy will contribute to managing their medical condition better.
Each patient’s physical therapy plan must be reviewed periodically to determine whether it remains relevant.
A doctor or physical therapist will oversee this review and then convey the findings to Medicare.
Physical therapists treat clients with prospective conditions that affect their movement. Evaluating persons and creating plans of care, physical therapists use the best practices for evaluation and treatment.
To monitor progress during treatment, physical therapists develop strategies that suit each need. After dozens of sessions, a plan review is required to ensure patients are being helped by therapy. If not, an alternative plan is developed and implemented.
To be eligible for Medicare payments for ongoing physical therapy, Medicare requires re-certification that continuing treatment is medically necessary.
After an individual’s doctor recommends physical therapy, Medicare pays for the person to participate in sessions to improve their strength and range of motion.
Now, in case after the physical therapy, they have not entirely reached their mobility goals, the individual will be required to sit with their doctor to discuss what needs to happen next.
The doctor and physical therapist then complete paperwork stating that continued medical services are necessary and submit it to Medicare.
When physical therapy services exceed $3,000, Medicare might have the physician and therapist featured in the patient’s records undergo a targeted medical review to make sure the billing for the cost of these services is appropriate and up-to-date and that the billing is in line with Medicare’s rules and regulations.
Most importantly, that such therapy continues to be medically warranted.
Medicare beneficiaries can choose to pay for physical therapy out of pocket or use their Medicare coverage.
If a person expects to use their Medicare benefits, the provider should notify them if Medicare will not cover the services received.
This helps them avoid unexpected healthcare costs.
If a person is not sure if Medicare covers physical therapy, they can ask their provider before starting the course of treatment.
If Medicare does not cover the physical therapy, the physical therapy practice should notify the person in writing before performing any treatment.
I am a dedicated healthcare researcher and an enthusiast specializing in medical grants, medical education and research. Through my articles, I aim to empower healthcare professionals and researchers with valuable insights and resources to navigate these critical aspects effectively.