Does Medicare Cover Physical Therapy?

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 when certain conditions are met, you would be responsible for the full cost if those conditions aren’t met.

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 prescribed by a healthcare provider.

Medicare covers medically necessary physical therapy regardless of whether it is part of a specific program, as long as it meets Medicare’s requirements.

Further, if you received physical therapy before your doctor authorized it, you may have to pay for those services yourself, since Medicare will not cover treatment that was not authorized by a doctor.

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 certain conditions.

Persons in the United States who cannot work due to a serious illness or disability may also qualify for Medicare.

Funds allocated for Medicare Advantage (Part C) physical therapy services are managed by private insurance companies under contract with the federal government, and these plans may have different copayments or prior authorization requirements than Original Medicare.

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, consult your Medicare plan or a Medicare representative, and ask your physician for a referral to a physical therapist.

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 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. Physical therapists use the best practices for evaluation and treatment when evaluating persons and creating plans of care.

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.

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.

If a person is unsure if Medicare covers physical therapy, they can ask their provider before starting treatment.

If Medicare does not cover physical therapy, the practice should notify the person in writing before performing any treatment.

See Also

Does Medicare Pay for Hospice

Does Medicare Pay for Shingle Shots

Does Medicare Cover Chiropractic

Does Medicare Cover Dental Implants