Does Medicare Cover Physical Therapy? Coverage and Costs

Reviewed by Dustin Brown, MS, FACHE. Last reviewed July 2026.

Good news if you need physical therapy: Medicare Part B covers medically necessary outpatient physical therapy, and the old hard dollar limit on therapy is gone. You do pay a share of the cost, and there are a few rules worth understanding. This guide explains what is covered and what you will pay. Coverage and costs change, so verify current details before relying on them.

The Short Answer

Yes. Part B covers medically necessary outpatient physical therapy when a provider certifies you need it, and there is no annual dollar cap. You pay 20% coinsurance after the Part B deductible. Importantly, coverage is not limited to therapy that makes you better; it also covers therapy to maintain your function or slow decline.

What Medicare Covers

Part B covers medically necessary outpatient physical therapy when a doctor or qualified provider certifies a plan of care. A key point that many people get wrong: Medicare covers therapy to maintain your current ability or slow a decline, so coverage should not be denied simply because you have plateaued and are no longer improving. Medicare also covers physical therapy in other settings, such as during a hospital stay, in a skilled nursing facility, or through home health care, though the cost rules differ in those settings.

The Therapy Cap Is Gone

The former hard dollar limit on outpatient therapy, the “therapy cap,” was repealed. In its place is a documentation threshold: once your physical therapy and speech-language therapy costs pass an annual amount (about $2,480 in 2026), your therapist simply adds a note attesting the care is still medically necessary. This is paperwork, not a cutoff, and medically necessary therapy continues to be covered.

What You Will Pay

After the Part B deductible (about $283 in 2026), you pay 20% of the Medicare-approved amount for each visit. A Medigap supplement policy can cover much or all of that 20%. Note that Medicare Advantage plans must cover medically necessary physical therapy too, but they often charge a fixed per-visit copay instead of 20% and may require prior authorization, a referral, or an in-network therapist, so check your plan’s rules before starting.

What to Do

Get your provider to certify a plan of care, and use a Medicare-enrolled therapist. If care is denied as “not medically necessary” or because you are “not improving,” you can appeal, since the maintenance-care standard supports coverage to hold your function steady. For in-home therapy, ask about the Medicare home health benefit if you are homebound. Your free SHIP counselor can help with questions or appeals.

If Your Therapy Is Denied or Cut Off

You have real protections here. If Medicare or a plan denies physical therapy as “not medically necessary,” or an agency says you no longer qualify because you have stopped improving, you can appeal, and the maintenance-care standard supports coverage to hold your function steady rather than only to improve it. If your services are being cut off, you can request an expedited or “fast” appeal. A note from your provider explaining why continued therapy is medically necessary, and that stopping would cause decline, is often decisive. Keep copies of your plan of care and progress notes.

Is There a Limit on Physical Therapy?

People often ask whether Medicare caps physical therapy. The old hard cap is gone.

Medicare no longer has a strict dollar limit on medically necessary therapy. Above a certain amount, your provider must confirm the therapy is still medically necessary. As long as it is, coverage continues. Your therapist handles this documentation.

Your Share of Therapy Costs

Physical therapy is covered, but you share the cost. Plan for it.

Under Part B, you typically pay a share after your deductible. A Medicare Advantage plan may have copays and require a referral or prior authorization. Ask your plan what you will owe per visit. Knowing this helps you budget for a course of therapy.

Medicare and Physical Therapy FAQs

Is there still a cap on physical therapy?

No hard cap. There is a threshold, about $2,480 in 2026, above which your therapist adds documentation, but medically necessary therapy keeps being covered.

What will I pay?

20% coinsurance after the Part B deductible. A Medigap policy can reduce this, and Medicare Advantage plans usually charge a per-visit copay instead.

Does Medicare cover PT if I am not getting better?

Yes. It covers therapy to maintain function or slow decline, not only to improve.

Does Medicare cover in-home physical therapy?

Yes, through the Medicare home health benefit if you qualify, for example if you are homebound and need skilled care. Different rules apply.

Do I need a referral?

Original Medicare requires a provider to certify a plan of care. Medicare Advantage plans may require prior authorization or a referral.

Can I appeal if my therapy is stopped?

Yes. You can appeal a denial or a cutoff, and the maintenance-care standard supports coverage to maintain function, not only to improve it.

Does Medigap help with therapy costs?

Yes. A Medigap policy can cover much or all of the 20% coinsurance you owe for outpatient physical therapy under Original Medicare.

Do I need a referral for physical therapy?

Original Medicare requires a provider to certify a plan of care rather than a formal referral, but Medicare Advantage plans may require prior authorization or a referral. Check your plan before starting.