Does Medicare Cover Physiotherapy Services?

Physiotherapy is a healthcare discipline focused on optimizing human movement and function, helping individuals recover from injuries, manage chronic conditions, and improve overall physical well-being. It employs various techniques, including exercises, manual therapy, and patient education, to restore, maintain, and enhance a person’s mobility and functional abilities. Physical therapists are trained professionals who assess, diagnose, and create personalized treatment plans.

Medicare Coverage Basics for Physiotherapy

Medicare offers coverage for medically necessary physiotherapy services under specific parts. Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), provides foundational coverage. Medicare Part B generally covers outpatient physiotherapy services, such as those received in clinics, private practices, or hospital outpatient departments. In contrast, Medicare Part A covers inpatient physiotherapy when it is part of a hospital stay or rehabilitation in a skilled nursing facility (SNF).

For services to be covered, Medicare requires them to be “medically necessary.” This means the services must be reasonable and essential for diagnosing or treating an illness, injury, or condition, aligning with accepted medical standards. The goal of medically necessary physiotherapy is often to restore function, reduce disability, or prevent further decline.

Medicare Advantage Plans (Part C), offered by private insurance companies approved by Medicare, also cover physiotherapy services. These plans must provide at least the same level of coverage as Original Medicare. However, Medicare Advantage Plans may have different network rules, cost-sharing structures, and may require prior authorization for services.

Eligibility and Service Requirements

For Medicare to cover physiotherapy, a healthcare provider, such as a doctor or physical therapist, must certify that the services are medically necessary. This typically involves a doctor’s order and the establishment of a certified plan of care that the therapist regularly reviews. The treatment must be designed to restore or improve physical movement after an injury, illness, or surgery, or to maintain current function and slow decline. It must also require the skills of a physical therapist and not be merely for convenience or general fitness.

While there is no longer a hard cap on how much Medicare pays for medically necessary outpatient physiotherapy services in a calendar year, review thresholds remain. For 2025, if the combined costs for physical therapy and speech-language pathology services exceed $2,410, or if occupational therapy costs exceed $2,410, the provider must confirm that the services remain medically necessary. Claims surpassing these thresholds may be subject to targeted medical review, particularly if they exceed $3,000, to ensure proper documentation of medical necessity.

Physiotherapy services can be covered in various settings. Outpatient clinics, private practices, and hospital outpatient departments are common venues for Part B covered services. Physiotherapy received in a skilled nursing facility can be covered under Part A if it follows a qualifying hospital stay of at least three consecutive days, with specific coverage periods and potential copayments. Home health services can also include physiotherapy if an individual meets the eligibility criteria for home care.

Understanding Your Costs

For Original Medicare Part B, after meeting the annual deductible, you typically pay 20% of the Medicare-approved amount for most outpatient therapy services. The Part B deductible for 2025 is $257. Medicare pays the remaining 80% of the approved amount.

Medicare Advantage Plans (Part C) have their own cost-sharing structures, which can include different deductibles, copayments, or coinsurance amounts for physiotherapy services. These costs vary significantly by plan, and it is important to review the specific plan’s benefits.

Medicare Supplement Insurance (Medigap) plans can help cover some of the out-of-pocket costs associated with Original Medicare, such as Part A and Part B deductibles, coinsurance, and copayments. Medigap policies are designed to work in conjunction with Original Medicare, reducing the financial burden on the patient.

Accessing Physiotherapy Services

A primary care physician or other healthcare provider typically needs to order or refer you for physiotherapy services. This referral confirms the medical necessity of the treatment.

To find Medicare-approved providers, you can use the Care Compare tool on Medicare.gov. This online tool helps locate professionals and group practices in your area that accept Medicare. It is advisable to confirm that the provider accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment and will only bill you for your deductible and coinsurance.

If you have a Medicare Advantage Plan, understanding your plan’s network rules is essential. Many Medicare Advantage plans operate with specific networks of providers (e.g., HMO or PPO plans), and using out-of-network providers may result in higher costs. Additionally, Medicare Advantage plans often require prior authorization for physiotherapy services, so it is important to ensure this is obtained before beginning treatment to avoid unexpected costs. If a claim for services is denied, you typically have the right to appeal the decision.