If you are recovering from surgery, managing a chronic condition, or dealing with an injury, you may be wondering: does Medicare cover physical therapy? The good news is that Medicare does cover physical therapy when it is medically necessary. But there are rules about costs, documentation, and coverage differences between Original Medicare and Medicare Advantage that every beneficiary should understand.
Does Medicare Cover Physical Therapy?
Yes. Medicare covers outpatient physical therapy when a doctor or other qualified healthcare provider determines it is medically necessary. This means the treatment must be intended to help you recover from an illness, injury, or surgery, or to maintain your current functional abilities with a chronic condition.
Medicare does not cover physical therapy for general fitness, prevention, or convenience. The treatment must be tied to a documented medical need.
Under Original Medicare, you do not need a referral to see a physical therapist. However, your therapist must certify that the treatment is medically necessary and maintain proper documentation throughout your care.
How Medicare Part B Covers Physical Therapy
Outpatient physical therapy falls under Medicare Part B. Here is how the cost structure works in 2026:
- Annual deductible: You pay the Part B deductible ($257 in 2026) before Medicare begins covering services
- Coinsurance: After the deductible, you pay 20% of the Medicare-approved amount for each session
- Medicare pays: 80% of the approved amount
For example, if a physical therapy session costs $150, Medicare pays $120 and you pay $30 in coinsurance. If you have a Medicare Supplement (Medigap) plan like Plan G, your Medigap plan typically covers that 20% coinsurance, bringing your out-of-pocket cost close to zero after meeting the deductible.
Is There a Limit on Physical Therapy Sessions?
This is one of the most common questions beneficiaries ask, and the answer may surprise you: there is no annual session limit for outpatient physical therapy under Medicare. Congress permanently eliminated the therapy cap in 2018.
However, Medicare does use therapy thresholds to monitor spending:
- $2,330 threshold (2026): Once your physical therapy costs exceed this amount for the year, your provider must include additional documentation confirming continued medical necessity
- Targeted medical review: Claims above the threshold may be flagged for review by Medicare Administrative Contractors
These thresholds are not caps. They are checkpoints. As long as your physical therapist documents that treatment remains medically necessary and you are making functional progress, Medicare continues to cover visits beyond these amounts.
What Types of Physical Therapy Does Medicare Cover?
Medicare covers a wide range of physical therapy services, including:
- Post-surgical rehabilitation: Recovery after hip replacement, knee replacement, heart surgery, or other procedures
- Injury recovery: Treatment for fractures, sprains, strains, and falls
- Stroke rehabilitation: Restoring movement, balance, and coordination after a stroke
- Chronic condition management: Physical therapy for arthritis, Parkinson’s disease, multiple sclerosis, or other ongoing conditions
- Balance and fall prevention: Therapeutic exercises to reduce fall risk in seniors
- Pain management: Treatment for chronic back pain, neck pain, or joint pain
Where Can You Receive Medicare-Covered Physical Therapy?
Medicare covers physical therapy in several settings:
- Outpatient clinics and private practices: Covered under Part B with 20% coinsurance
- Hospital outpatient departments: Covered under Part B (note: hospital-based therapy may cost more due to facility fees)
- Skilled nursing facilities (SNFs): Covered under Part A during a qualifying inpatient stay (first 20 days at no cost, days 21-100 with daily coinsurance)
- Home health care: Covered under Part A or Part B when you are homebound and need skilled therapy services
- Inpatient rehabilitation facilities: Covered under Part A for intensive rehab programs
Where you receive therapy affects your costs. Hospital outpatient departments often charge higher facility fees than private clinics for the same services.
Physical Therapy Coverage Under Medicare Advantage
If you have a Medicare Advantage plan (Part C), physical therapy is covered because all Advantage plans must provide at least the same benefits as Original Medicare. However, there are key differences:
- Prior authorization: Many Medicare Advantage plans require prior authorization before starting physical therapy
- Network restrictions: You may need to use in-network physical therapists to get the lowest copay
- Copay structure: Instead of 20% coinsurance, Advantage plans often charge a flat copay per visit (commonly $20 to $40)
- Session limits: Some Advantage plans impose annual visit limits that Original Medicare does not have
Always check your plan’s Evidence of Coverage document or call your plan directly to confirm your physical therapy benefits before starting treatment.
How to Make Sure Your Physical Therapy Is Covered
Follow these steps to avoid surprise bills and coverage denials:
- Get a physician’s order: While a referral is not technically required under Original Medicare, having a documented order from your doctor strengthens your claim
- Choose a Medicare-accepting provider: Confirm your physical therapist accepts Medicare assignment (agrees to the Medicare-approved amount)
- Verify network status (Advantage plans): If you have Medicare Advantage, confirm the therapist is in your plan’s network
- Ask about prior authorization: Medicare Advantage members should check if prior authorization is needed before the first visit
- Track your therapy costs: Monitor your total spending against the therapy threshold to anticipate any additional documentation requirements
- Request an Advance Beneficiary Notice (ABN): If your therapist believes Medicare may not cover a specific service, they should provide an ABN so you can decide whether to proceed
What Medicare Does Not Cover
Understanding the limits is just as important as knowing what is covered. Medicare generally does not pay for:
- Physical therapy for general fitness or exercise programs
- Maintenance therapy that could be done independently without skilled care (with some exceptions)
- Treatment that is not documented as medically necessary
- Services from providers who do not accept Medicare
An important clarification: Medicare does cover maintenance therapy when skilled care is needed to maintain function or prevent decline, even if you are not expected to improve. This was clarified after the Jimmo v. Sebelius settlement, which established that the “improvement standard” cannot be used to deny coverage.
How Medigap Plans Help With Physical Therapy Costs
If you have Original Medicare, a Medicare Supplement (Medigap) plan can significantly reduce your physical therapy expenses. Popular plans like Plan G and Plan N cover the 20% coinsurance that Part B leaves you responsible for.
With Plan G specifically, once you meet the annual Part B deductible, your Medigap plan covers the remaining coinsurance for physical therapy visits. This means your out-of-pocket cost per session drops to essentially zero for the rest of the year.
For beneficiaries who need ongoing or frequent physical therapy, this coverage gap protection can save hundreds or even thousands of dollars annually.
Frequently Asked Questions
Does Medicare require a referral for physical therapy?
No. Under Original Medicare, you do not need a referral to see a physical therapist. However, your therapist must document that the treatment is medically necessary. Some Medicare Advantage plans may require a referral or prior authorization, so check your plan’s requirements.
How many physical therapy sessions does Medicare cover per year?
There is no annual session limit for outpatient physical therapy under Medicare. The therapy cap was permanently eliminated in 2018. Medicare uses spending thresholds (around $2,330 in 2026) that trigger additional documentation requirements, but these are not caps on the number of visits.
Does Medicare cover physical therapy at home?
Yes. Medicare covers home health physical therapy if you are homebound and require skilled therapy services. A doctor must order the care, and it must be provided by a Medicare-certified home health agency.
What is the cost of physical therapy with Medicare?
Under Original Medicare Part B, you pay 20% coinsurance after meeting the annual deductible ($257 in 2026). For a $150 session, you would pay approximately $30. If you have a Medigap plan like Plan G, your coinsurance is typically covered, reducing your cost to zero after the deductible.
Does Medicare Advantage cover physical therapy?
Yes. All Medicare Advantage plans must cover at least the same physical therapy benefits as Original Medicare. However, Advantage plans may require prior authorization, limit you to in-network providers, or impose annual visit limits that Original Medicare does not have.
Does Medicare cover physical therapy for back pain?
Yes, if a doctor determines that physical therapy is medically necessary for your back pain. This includes chronic lower back pain, herniated discs, spinal stenosis, and post-surgical rehabilitation. Your therapist must document the medical necessity throughout treatment.