How Much Physical Therapy Does Medicare Cover?

How much physical therapy does Medicare cover?
Medicare does not set a hard limit on the number of physical therapy sessions. Coverage depends on medical necessity. In 2025, Medicare Part B pays up to $2,410 for outpatient physical therapy before requiring a doctor’s recertification, and once costs exceed $3,000, claims may face a targeted medical review. Patients pay 20% coinsurance after meeting the annual deductible.

Why Physical Therapy Matters for Seniors

Physical therapy (PT) is one of the most common forms of rehabilitation for older adults. It helps with recovery after surgery, stroke, fractures, and chronic conditions like arthritis. Many seniors rely on PT to stay mobile and independent, which makes Medicare coverage critical. Without coverage, the cost of repeated sessions could quickly become overwhelming, with average prices ranging between $50 and $350 per visit depending on location and complexity.

Key Points of Medicare Physical Therapy Coverage

1. No Set Session Limit

Medicare does not restrict the number of physical therapy sessions you can receive each year. Instead, coverage is based on whether the therapy is medically necessary—meaning a doctor or qualified healthcare professional confirms that PT is needed to treat or improve a condition.

2. Coverage Thresholds in 2025

• $2,410 threshold: Once outpatient PT costs exceed this amount in a calendar year, your provider must recertify that therapy is medically necessary for coverage to continue.

• $3,000 targeted review: If costs reach or exceed this level, Medicare may flag the claim for additional review to ensure appropriate use.

These thresholds are not “caps” but checkpoints to confirm therapy remains beneficial.

3. Cost Sharing Under Part B

• Deductible: Beneficiaries must first meet the annual Part B deductible (about $257 in 2025).

• Coinsurance: After the deductible, you pay 20% of the Medicare-approved amount per session, while Medicare covers the remaining 80%.

• Example: If a session costs $100, Medicare pays $80 and you pay $20 after meeting the deductible.

4. Coverage Under Part A (Inpatient Care)

If you are admitted to a hospital or skilled nursing facility, Medicare Part A may cover PT as part of your inpatient treatment. The costs fall under hospital stay benefits rather than outpatient therapy rules.

5. Medicare Advantage Plans (Part C)

Private Medicare Advantage plans must cover at least what Original Medicare covers, but they may offer:

• Expanded therapy benefits

• Lower out-of-pocket costs

• Network restrictions (you may need to use in-network PT providers)

It’s important to compare plan details, as Advantage plans can vary widely.

6. Documentation and Recertification

Therapists must maintain a care plan that shows goals, progress, and ongoing need for therapy. This documentation becomes critical once costs exceed the $2,410 threshold, since Medicare requires physician approval for continued sessions.

What Physical Therapy Services Are Covered?

Medicare covers PT when it is deemed reasonable and necessary. Covered services typically include:

• Evaluation of mobility and functional needs

• Therapeutic exercises to improve strength, flexibility, and balance

• Gait training for safe walking with or without devices

• Neuromuscular re-education for conditions like stroke recovery

• Training in the use of assistive devices (walkers, canes, braces)

• Manual therapy and techniques to restore movement

However, maintenance therapy—when therapy is given only to maintain current function without expectation of improvement—may not always be covered unless justified by a medical provider.

Common Scenarios Where Medicare Covers PT

1. Post-Surgery Rehabilitation
   Example: After a knee or hip replacement, PT is covered to help regain strength and mobility.

2. Stroke Recovery
   PT is essential for relearning motor skills, balance, and coordination.

3. Chronic Conditions
   People with arthritis, Parkinson’s disease, or multiple sclerosis often use PT to improve daily living.

4. Injury Recovery
   Falls and fractures are common in older adults, and PT is covered to speed healing and prevent future injuries.

Out-of-Pocket Costs Explained

Even with Medicare coverage, you will have expenses. For example:

• Scenario A: You attend 10 sessions at $100 each.

  • Total = $1,000

  • Medicare pays $800

  • You pay $200 (after deductible)

• Scenario B: You attend 40 sessions at $100 each.

  • Total = $4,000

  • Medicare pays about $3,200

  • You pay about $800

These examples show why coinsurance adds up quickly and why supplemental insurance (Medigap) or a Medicare Advantage plan can help reduce costs.

Frequently Asked Questions (FAQ)

Q1: Is there a hard cap on Medicare physical therapy sessions?
No. There is no yearly limit. Coverage continues as long as PT is medically necessary.

Q2: What happens if I exceed the $2,410 threshold?
Your doctor must confirm that ongoing therapy is necessary, and Medicare will continue to cover sessions.

Q3: What if my therapy costs exceed $3,000?
Medicare may conduct a targeted medical review, checking documentation to confirm services are appropriate.

Q4: Does Medicare cover physical therapy at home?
Yes, if you qualify for home health services and PT is ordered by your doctor. The care must be medically necessary and provided by a Medicare-certified home health agency.

Q5: Does supplemental insurance help with PT costs?
Yes. Medigap plans typically cover the 20% coinsurance, greatly reducing out-of-pocket expenses.

Q6: How do Medicare Advantage plans differ?
Some Advantage plans may offer more generous PT benefits, but they may restrict you to in-network providers or require pre-authorization.

Q7: Can I receive PT in a skilled nursing facility?
Yes, if you qualify for Part A coverage after a hospital stay. PT is usually included in your daily care during rehabilitation.

Tips for Maximizing Medicare PT Coverage

• Get a clear treatment plan. Work with your therapist to set goals and timelines.

• Keep documentation updated. Ensure your therapist submits progress notes and re-certifications promptly.

• Ask about therapy alternatives. Sometimes group therapy or home exercise programs can supplement formal PT.

• Review your Medicare Advantage plan. See if additional PT benefits are available.

• Consider Medigap coverage. It can eliminate coinsurance payments and reduce overall costs.

• Consult your physical therapist to understand how many sessions may be required for your recovery.

• Ask your doctor to recertify therapy if your costs approach the Medicare threshold.

• Review your insurance options to minimize coinsurance expenses.

• Start now: The sooner you begin physical therapy, the faster you can regain strength and independence.