How Many Physical Therapy Sessions Does Medicare Cover?
Navigate Medicare's physical therapy coverage. Learn about medical necessity, financial considerations, and plan differences for your rehabilitation needs.
Physical therapy plays a significant role in recovery and managing various health conditions, helping individuals regain strength, mobility, and function. It can be a component of rehabilitation after an injury, surgery, or for chronic conditions affecting movement. Understanding how Medicare covers these services is important for beneficiaries seeking care.
Medicare Part B Coverage for Physical Therapy
Original Medicare, specifically Part B, covers outpatient physical therapy services when medically necessary. A physician must order the services, and a qualified therapist must provide them. Coverage extends to various settings, including private practices, outpatient hospital departments, and skilled nursing facilities. A physical therapist or other qualified professional develops a plan of care that the doctor reviews and certifies.
Medicare Part B does not impose a numerical limit on physical therapy sessions. As long as services remain medically necessary and are delivered by an approved provider, Medicare generally covers them. A financial threshold may trigger additional review processes, but it does not automatically stop coverage.
Understanding the Therapy Threshold
Medicare sets an annual financial threshold for combined outpatient physical therapy and speech-language pathology services. For 2025, this threshold is $2,410. A separate $2,410 threshold applies to occupational therapy services. These amounts are adjusted annually to reflect changes in healthcare costs.
When therapy expenses reach the $2,410 threshold, providers must attest to the medical necessity of continued services by appending a KX modifier to the claim. This indicates services are reasonable, necessary, require a licensed therapist’s skills, and are supported by documentation. Services exceeding this amount can still be covered if they meet these criteria.
Beyond this, a higher targeted medical review threshold exists, which for 2025 is $3,000 for combined physical therapy and speech-language pathology services, and a separate $3,000 for occupational therapy. Claims exceeding this amount may be subject to a targeted medical review by Medicare. This review ensures services are provided appropriately and meet Medicare’s requirements.
Costs and Coverage for Physical Therapy
Beneficiaries are responsible for out-of-pocket costs under Original Medicare. After meeting the annual Part B deductible, Medicare typically pays 80% of the Medicare-approved amount for physical therapy services. The beneficiary is then responsible for the remaining 20% coinsurance. For 2025, the annual Part B deductible is $257.
Medicare Supplement Insurance (Medigap) can help cover these out-of-pocket costs. Medigap plans are offered by private insurance companies and pay for some costs Original Medicare does not cover.
Medicare Advantage Plans and Physical Therapy
Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits. These plans are provided by private insurance companies approved by Medicare. By law, Medicare Advantage plans must cover at least the same benefits as Original Medicare, including medically necessary physical therapy.
While Medicare Advantage plans must provide the same level of coverage, they may have different rules, costs, and restrictions for physical therapy services. These differences can include referral requirements, specific provider networks, or varying copayments or coinsurance amounts per session. Beneficiaries should review their specific plan’s benefits and network rules to understand their financial responsibility and access to physical therapy.