Does Medicare Pay for Telehealth Physical Therapy?

Telehealth has become a significant component of modern healthcare delivery, offering a convenient way for individuals to access medical services remotely. This digital transformation extends to physical therapy, allowing patients to receive care from home. As more people explore remote healthcare, a common inquiry arises regarding Medicare’s coverage for telehealth physical therapy. This article clarifies Medicare’s current position on these services and what beneficiaries can expect.

Medicare Coverage for Telehealth Physical Therapy Services

Medicare Part B generally provides coverage for medically necessary outpatient physical therapy services, and this coverage has expanded to include telehealth delivery. Physical therapists, along with physical therapist assistants, are recognized as eligible providers for furnishing these telehealth services. Many of the same physical therapy services received in person can now be accessed remotely.

The types of physical therapy services covered via telehealth include initial evaluations, re-evaluations, therapeutic exercises, neuromuscular re-education, gait training, therapeutic activities, and self-care/home management training. The Centers for Medicare & Medicaid Services (CMS) has specified Current Procedural Terminology (CPT) codes eligible for telehealth billing.

Reimbursement for these telehealth physical therapy services is typically set at the same rate as comparable in-person services. This parity in payment encourages providers to offer remote options, ensuring equitable access to necessary care.

Conditions for Medicare Coverage

For Medicare to cover telehealth physical therapy services, several specific conditions must be met regarding the provider, the patient, the technology used, and documentation. The physical therapist providing the service must be licensed and enrolled in Medicare, ensuring they can bill the program.

Patient eligibility hinges on the medical necessity of the service, meaning a physician or other healthcare provider must certify that the physical therapy is required for diagnosis or treatment. A signed plan of care from a licensed physician or non-physician practitioner (NPP) is essential and typically needs to be obtained within 30 days of the patient’s first visit.

Regarding technology, telehealth services must be delivered using real-time audio and video equipment that allows for two-way, interactive communication. Audio-only services are generally not eligible for physical therapy. Patients can receive these services from any location, including their home, through September 30, 2025. After this date, traditional originating site requirements may apply.

Proper documentation is a condition for Medicare coverage. Claims must include the appropriate CPT codes along with a modifier, such as modifier 95, to indicate that the service was provided via synchronous telehealth. Providers must maintain clear records of the type of technology used, the start and end times of the session, and the patient’s verbal consent to receive telehealth services.

Understanding Costs and Billing

When receiving telehealth physical therapy services under Medicare, beneficiaries are responsible for the standard cost-sharing associated with Medicare Part B. After meeting the annual Part B deductible, which is $257 in 2025, patients typically pay 20% of the Medicare-approved amount for these services. This coinsurance applies to telehealth visits in the same way it would for in-person appointments. Providers are expected to bill Medicare for the services rendered, and beneficiaries will then be responsible for their share of the costs.

For beneficiaries enrolled in Medicare Advantage (Part C) plans, the coverage for telehealth physical therapy will at least match that of Original Medicare. Many Medicare Advantage plans may offer additional telehealth benefits beyond what Original Medicare covers, potentially including services from home without location restrictions. However, the specific details regarding coverage, cost-sharing, and any additional benefits can vary significantly between different Medicare Advantage plans. Beneficiaries with these plans should consult their plan documents or contact their plan provider directly to understand their specific telehealth physical therapy benefits and associated costs.

Accessing Telehealth Physical Therapy

Patients seeking telehealth physical therapy services under Medicare can take several steps to find and utilize these benefits. First, identify a physical therapist who is enrolled in Medicare and offers telehealth options. Many physical therapy clinics have integrated telehealth into their services.

To locate a suitable provider, beneficiaries can contact their current physical therapist or primary care physician for referrals. Online directories or Medicare’s official website may also provide lists of participating providers.

Once a provider is identified, schedule an appointment and confirm that the specific services needed are covered via telehealth. Preparing for a telehealth session involves ensuring a quiet, private space free from distractions, along with a stable internet connection and a device equipped with a camera and microphone. This setup facilitates clear communication and visual assessment during the session.

It is also advisable to have any relevant medical records, a list of medications, and a clear understanding of the physical therapy goals ready before the appointment. Confirming the technology platform the therapist uses and performing a quick test beforehand can help prevent technical issues.