Does Medicare Cover Physical Therapy? Find Out Here

Does Medicare Cover Physical Therapy

For one reason or another, you may need physical therapy, and at 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.

This article seeks to determine if Medicare covers physical therapy, so you may want to stick around.

Which Parts of Medicare Cover Physical Therapy

Medicare covers physical therapy when it is medically necessary and either prescribed by a doctor or provided by (or under the supervision of) doctors or other healthcare providers.

Medicare covers medically necessary physical therapy in various settings including outpatient clinics, skilled nursing facilities, home health care, and inpatient rehabilitation facilities, each with different coverage rules.

If you receive physical therapy without proper authorization, Medicare may deny coverage, making you responsible for the full cost of services.

Medicare, the United States’ national health insurance program, covers physical therapy as a medical service. Medicare coverage is generally available to U.S. citizens and legal residents aged 65 or older, and to some younger individuals with disabilities or specific conditions.

Persons residing in the United States who cannot work due to injury by illness or those experiencing medical complications may qualify for Medicare.

Medicare Administrative Contractors (MACs) process physical therapy claims for Original Medicare, while Medicare Advantage plans are administered by private insurance companies.

How Much Does Physical Therapy Cost?

Please consult with your physician and ask for a referral to a physical therapist 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.

That said, physical therapy costs vary across the nation.

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 improve their management of their medical condition.

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. They use the best evaluation and treatment practices when evaluating people and creating plans of care.

Physical therapists develop strategies that suit each patient’s needs to monitor progress during treatment. Medicare requires a progress review by the therapist every 10 treatment days or at least once every 30 days, not after “dozens of sessions. If not, an alternative plan is developed and implemented.

Medicare requires re-certification that continuing treatment is medically necessary to be eligible for Medicare payments for ongoing physical therapy.

What Next

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, if they have not entirely reached their mobility goals after the physical therapy, the individual will be required to sit with their doctor to discuss what needs to happen next.

The doctor and physical therapist then completed paperwork stating that continued medical services are necessary and submitted it to Medicare.

Most importantly, such therapy continues to be medically warranted.

Conclusion

Medicare beneficiaries can 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.

Providers must issue an Advance Beneficiary Notice of Noncoverage (ABN) before providing services they believe Medicare may not cover.

Suppose a provider believes Medicare may deny payment for physical therapy. In that case, they must provide an Advance Beneficiary Notice of Noncoverage (ABN) before treatment, allowing the patient to decide whether to receive the service and pay out-of-pocket.

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Does Medicare Cover Physical Therapy