Does Medicaid Cover Physical Therapy?

Physical therapy is often essential for recovery after injury, surgery, or managing chronic conditions. If you rely on Medicaid, you may be asking: Does Medicaid cover physical therapy? The answer is yes—but coverage depends on your state and medical necessity.

Quick Answer 

Medicaid generally covers physical therapy when it is medically necessary, but the number of visits, eligible providers, and specific services vary by state. Some states may limit sessions per year or require prior authorization.

How Medicaid Covers Physical Therapy

1. Medical Necessity Requirement

Medicaid will typically pay for physical therapy if a doctor prescribes it as part of treatment for illness, injury, or rehabilitation.

2. State-by-State Differences

Because Medicaid is jointly funded by federal and state governments, coverage details differ:

• Some states cover unlimited visits if medically necessary.

• Others limit the number of sessions (e.g., 20 per year).

• Prior authorization may be required.

3. Eligible Providers

Coverage usually applies when therapy is provided by a licensed physical therapist in an approved facility, hospital, or outpatient clinic.

4. Costs for Patients

Most Medicaid beneficiaries pay little to no out-of-pocket costs. Some states may charge small co-pays for each visit.

Key Points

• Medicaid covers physical therapy if it is medically necessary.

• Coverage rules differ by state—some allow unlimited visits, others limit sessions.

• A doctor’s referral or prior authorization may be required.

• Services must be provided by Medicaid-approved facilities or therapists.

• Out-of-pocket costs are usually minimal.

FAQ

1. Does Medicaid cover physical therapy after surgery?
Yes, if a doctor prescribes it for recovery, most states will cover post-surgery physical therapy.

2. Is there a limit to how many sessions Medicaid covers?
Yes, some states cap the number of sessions per year, while others allow more based on medical necessity.

3. Do I need a referral for Medicaid physical therapy?
In most states, a doctor’s referral or prior authorization is required.

4. Can children get physical therapy under Medicaid?
Yes, children covered under Medicaid or CHIP often receive broader therapy benefits under EPSDT (Early and Periodic Screening, Diagnostic, and Treatment).

5. What if my state limits therapy sessions?
Your provider can request an exception or extension if additional sessions are medically necessary.

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