Does Medicare Cover Physical Therapy?
Entrusted Legacy Law
Feb 03, 2023
Pennsylvania - Greater Pittsburgh Area
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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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