Does Medicare Cover Physical Therapy?
Entrusted Legacy Law
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Feb 03, 2023
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Physical therapy helps elders recover from injuries and
illnesses, manage chronic conditions, and prevent future injuries. It can be an
essential component of health care for older adults.
Medicare covers physical therapy (PT) when it is medically
necessary to treat a disease or injury, according to Medicare.gov. Those
who qualify for Medicare because of age or disability could receive covered
physical therapy services.
What Is Physical Therapy?
Physical therapy helps people improve their balance,
movement, muscle strength, joint mobility, and overall health. Highly trained
professionals specializing in activity and exercise prescribe exercises to help
patients enhance their physical capabilities and control pain.
Older adults can require physical therapy for several
reasons. Following a health incident, such as a neurological event, surgery, or
a fall, physical therapy can help a patient restore mobility. For instance, a
physical therapist could help a stroke patient regain movement. WebMD reports
that physical therapists can also help older adults with such conditions as
osteoporosis, balance problems, certain cancers, and incontinence.
PT helps people recover from injuries and manage chronic
conditions, while also reducing the risk of future injuries. In addition, it
may help prevent injuries and mitigate functional declines associated with
aging, according to the National Council on Aging.
The Benefits of Physical Therapy
In treating and preventing injuries, physical therapy can
benefit many older adults, as it helps restore and maintain physical health. PT
may:
- Reduce
pain. After undergoing treatment, you may need less pain
medication. Research shows that physical therapy significantly
reduces patients’ long-term opioid use.
- Expedite
recovery. According to Medicare.org, physical therapy can
speed up recovery following an injury or surgical procedure. It can also
reduce the need for future surgeries.
- Preserve
your autonomy. Physical therapists can help seniors to maintain
their independence. With physical therapy, older adults may continue to
perform activities of daily living on their own, like showering, using the
toilet, and dressing.
- Improve
mobility. Per St. Luke’s Health, PT can help older
adults can continue to move around without a cane or walker. For people
with Parkinson’s, prescribed PT exercises can help increase mobility as
well. As John Hopkin’s Medicine reports, physical therapists can
help patients reinforce movements that the disease affects.
- Lower
your risk of falling. Seniors can reduce their risks of falls
with PT. According to the Centers for Disease Control and Prevention,
one in four Americans over 65 suffers a fall every year. Improving
flexibility, strength, and balance can help older adults avoid
falls.
When Does Medicare Pay for Physical Therapy?
Given the benefits of physical therapy, Medicare recipients
might seek services to treat injuries, manage chronic conditions, and maintain
physical health.
Medicare helps cover the cost of PT in certain
circumstances. A doctor or another health care provider, such as a nurse
practitioner, clinical nurse specialist, or physician assistant, must certify
that the patient needs physical therapy.
Qualifying beneficiaries can get covered PT services via
Medicare Part A or Part B.
- Part A
covers physical therapy in inpatient facilities, such as hospitals,
skilled nursing facilities, and rehabilitation centers, according to AARP.org.
For homebound individuals eligible for home health benefits, Part A covers
in-home PT, where a therapist visits the patient at their residence.
Out-of-pocket costs depend on where the patient receives services.
- Outpatient
physical therapy services fall under Part B.
This includes PT in any of the following:
- a
doctor or therapist’s office
- a
hospital outpatient department
- a
skilled nursing facility providing outpatient care
Medicare Part B also covers in-home PT when an individual doesn’t
receive Part A home health benefits.
Once individuals pay the Part B deductible, which is $226 in
2023, Medicare covers outpatient PT. When coverage kicks in, beneficiaries are
responsible for 20 percent of the Medicare-approved payment. This may include
outpatient occupational therapy, physical therapy, and speech-language
pathology.
Be sure to ask your health care provider any questions you may have about coverage for PT services or related tests. Speak with an elder law attorney in your area as well to learn more about Medicare.
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