Medicare eliminated the therapy cap in 2018. However, your provider will still need to assert services are medically necessary.
Physical therapy is care that evaluates and treats injuries and diseases that change your ability to function, and/or improves or maintains current function or slows decline. You may need physical therapy if you’re having issues with your ability to move, limitations or injuries that are keeping you from everyday activities, or chronic pain.
Inpatient physical therapy is covered by Medicare Part A (hospital insurance). Outpatient physical therapy (as well as speech-language pathology and occupational therapy) is covered by Part B (medical insurance) when your doctor or provider certifies you need it. However, outpatient programs can be expensive, so it’s important to know how much is covered and how much it will cost you so you can financially prepare.
How much does physical therapy cost with Medicare
Inpatient physical therapy costs
If you have Medicare Part A, you must pay your annual deductible ($1,600 per benefit period in 2023). This is for physical therapy services received in a:
- Acute-care rehabilitation center
- Skilled nursing facility (SNF)
- Or, at home after a three-day hospital stay
After meeting the deductible, Medicare will cover 100% of the cost of physical therapy for the first 60 days of inpatient services. Between days 60 and 90, you’ll be charged a daily coinsurance of $400 per day. After day 91, there’s an $800 daily co-insurance payment for each lifetime reserve day used.
After the maximum lifetime 60 lifetime reserve days are used, there is no more coverage under Part A. You would have to pay 100% of the cost out-of-pocket. (All Medigap plans give you an additional 365 lifetime reserve days for inpatient care.)
Outpatient physical therapy costs
After you meet the Part B deductible ($226 in 2023), you pay 20% of the Medicare-approved amount for physical therapy services. Medicare pays the other 80%.
There used to be limits, known as the therapy cap, on how much outpatient therapy Original Medicare covered annually. However, this limit was removed in 2018. There is currently no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.
That said, if your total therapy costs reach a certain amount, your provider is required to confirm that it is still medically necessary. In 2023, Medicare covers up to $2,230 for physical therapy before requiring your provider to confirm your care is medically necessary.
Note that Medicare has strict rules about who can provide physical therapy and how much they can charge for it, so talk to your doctor or provider to ensure these services are covered. Covered outpatient therapy services include therapy received at:
- A therapists’ or doctors’ office
- A Comprehensive Outpatient Rehabilitation Facilities (CORFs)
- An SNF when you are there as an outpatient
- Home through therapists connected with home health agencies (when you are ineligible for Medicare’s home health benefit)
These rules do not apply if you are receiving therapy as part of a covered SNF stay or Medicare-covered home healthcare.
Medicare Advantage physical therapy costs
Medicare Advantage plans (Part C) offer extra benefits that Original Medicare does not, sometimes including expanded physical therapy coverage. You will likely have co-pays or co-insurance as out-of-pocket costs, but exact costs depend on your plan.
Know that in some cases, a Medicare Advantage plan may require prior authorization before you start physical therapy. Your doctor can request authorization by providing proof that physical therapy is medically necessary for you.
Whether you’re looking for an Advantage plan, Part D, or Medigap coverage, you can find it with our Find a Plan tool. Just enter your zip code to start comparing the costs and benefits of Medicare plans in your area.
Medigap physical therapy costs
Medicare Supplement plans, or Medigap, help cover out-of-pocket costs including deductibles, co-pays, and co-insurance from Medicare Parts A and B.
If you need inpatient physical therapy, your Medigap plan will cover Part A co-insurance and most of the deductible.
Additionally, every standardized Medigap plan (other than high-deductible plans K and L) fully covers Part B co-pays and co-insurance, so outpatient physical therapy will likely be 100% covered. You would have no out-of-pocket costs, but the plan you choose and your health needs will determine to what extent your costs are covered.
10 tips for choosing the right physical therapist
Know your coverage
Make sure to check with your doctor and your Medicare plan to understand the specific details of your coverage, including what services are and aren’t covered and what you’ll owe out-of-pocket. Have the physical therapist’s office verify acceptance of your plan.
Ask for a referral
In some cases, you may need a referral from your primary care provider, but even if you don’t, ask your doctor if they have a therapist or facility they recommend. You can also ask friends, family, and coworkers for recommendations.
Do your research
Call and visit as many clinics as you can and get as much information as possible to ensure you make an informed decision. Read about their services and programs online, as well as reviews from past or current clients.
Choose a location that’s convenient for you
Working with a therapist in a location that’s close to your home or workplace will make it easier for you to keep appointments and continue your care for as long as you need.
Look for Medicare plans that cover physical therapy
Consider their experience
Ensure they are licensed and ask about any certifications, credentialing, or advanced education. The more experience they have, the better your results will be.
Ask about specialized programs or resources
If you need a special or particular type of rehab or specific equipment, make sure the location and therapist you’re working with offers them. Some locations provide specialized programs specific to certain needs, and some therapists focus on a particular condition or age group or practice in specific settings. Make sure the therapist is prepared for your condition and needs.
Consider communication skills and style
You should feel connected to your therapist and satisfied with the information given to you. You should understand what the therapist is sharing with you and feel like they are understanding you in return. You should have a strong working relationship with your therapist, trusting their advice and having open, honest communication.
Ensure they have great manual skills
Physical therapists use their hands to mobilize, manipulate, produce motion, and improve function that patients can’t accomplish on their own through stretching, strengthening, or other exercise. They should be able to get a sense of areas of inflammation, pain, and motor restrictions using their hands.
Make sure they are skilled at treating your specific injury or disease
Choose a therapist who has worked with patients who have your specific condition. You may want to find a specialist in a certain area to ensure your success.
Try it out
Physical therapy is a partnership, so your physical therapist should be someone with whom you get along, have a good rapport, and feel comfortable. During your first visit, the therapist will thoroughly evaluate you and help you set up a realistic and concrete plan to get you back on track.
Your therapist should be passionate, caring, and inspiring, and if you don’t feel a connection, consider switching to a different one. It’s important to work with a physical therapist who will help you reach all of your goals, and it’s ok to decide they aren’t right for you and to find one who is.