How Many Physical Therapy Sessions Does Medicare Cover?

Introduction

Physical therapy is an important part of health care that helps individuals recover from injuries and illnesses, manage chronic conditions, and improve overall mobility. It is commonly prescribed by doctors for those who have had a surgery or other medical procedure, as well as for those who are dealing with chronic pain or movement issues. But for those who rely on Medicare for their health care coverage, understanding what is and isn’t covered can be tricky. This article will explore how many physical therapy sessions does Medicare cover, as well as the cost of these sessions.

Exploring Medicare Coverage for Physical Therapy Sessions

Medicare Part B (Medical Insurance) covers medically necessary physical therapy services provided by a qualified physical therapist in a variety of settings, including hospitals, outpatient clinics, skilled nursing facilities, and home health agencies. Generally speaking, Medicare will cover up to 80% of the approved amount for each physical therapy session, but there are some limits and restrictions. It is important to understand what is and isn’t covered before scheduling an appointment.

What is Covered?

According to the Centers for Medicare & Medicaid Services (CMS), Medicare Part B covers the following physical therapy services:

• Evaluation and assessment of physical therapy needs
• Exercises to increase strength and range of motion
• Training in balance and coordination
• Gait training
• Manual therapy techniques
• Assistive devices (e.g., walkers and canes)

What is Not Covered?

Medicare Part B does not cover any physical therapy services that are not deemed medically necessary. According to CMS, this includes “services that are custodial, supportive, maintenance, or preventative in nature; services that are educational in nature; services related to sports medicine; services that are recreational in nature; and services that are primarily for the convenience of the patient or family.”

Unpacking the Cost of Physical Therapy with Medicare

The cost of physical therapy services covered by Medicare Part B depends on several factors, including the type of service, the setting in which it is provided, and the deductible and coinsurance amounts. In general, Medicare pays 80% of the approved amount after the patient has met their deductible, while the patient is responsible for the remaining 20%. It is important to note that not all providers accept Medicare, so it is important to check with your provider before scheduling an appointment.

Deductibles and Copayments

Medicare Part B requires patients to pay a yearly deductible before they can start receiving coverage for their physical therapy services. The current deductible for 2020 is $198 per year. After the deductible is met, patients are responsible for paying a copayment for each physical therapy session. The copayment amount varies depending on the type of service and the setting in which it is provided.

Additional Expenses Not Covered by Medicare

It is important to note that there may be additional expenses associated with physical therapy services that are not covered by Medicare. These include charges for supplies, equipment, and other services that are not considered medically necessary. For example, if you need to use a special machine or device during your physical therapy session, you may be responsible for the cost of renting or purchasing it. It is important to check with your provider to see if there are any additional charges you should be aware of.

Maximizing Your Medicare Benefits for Physical Therapy

There are several ways to maximize your Medicare benefits for physical therapy. First, be sure to take advantage of any special programs or discounts that may be available. Many providers offer discounted rates for seniors and those with limited incomes. Additionally, it is important to understand the limits of your plan and make sure you are getting the most out of your coverage. Some plans have caps on the number of physical therapy sessions they will cover, so be sure to ask about this before scheduling an appointment.

How Many Physical Therapy Sessions Does Medicare Cover?

The answer to this question depends on several factors, including the type of service, the setting in which it is provided, and the limits of your plan. Generally speaking, Medicare Part B will cover up to 80% of the approved amount for each physical therapy session, but there may be limits on the number of sessions that are covered. Additionally, some plans may have an annual cap on the number of physical therapy sessions they will cover.

Factors to Consider

When determining how many physical therapy sessions Medicare will cover, it is important to take into account the type of service being provided, the setting in which it is being provided, and the limits of your plan. Additionally, it is important to consider the cost of any additional services or supplies that may be needed. For example, if a particular device or piece of equipment is needed for the physical therapy session, you may be responsible for the cost of renting or purchasing it.

Maximum Number of Sessions

Although there is no set maximum number of physical therapy sessions that Medicare will cover, most plans will limit the number of sessions that can be covered in a given year. According to research published in the Journal of Physical Therapy Science, the average number of physical therapy sessions covered by Medicare Part B is 18-20 per year. However, this number may vary depending on the type of service being provided and the limits of your plan.

What You Need to Know About Medicare Coverage for Physical Therapy

Medicare Part B covers many physical therapy services, but there are some limitations and restrictions. It is important to understand what is and isn’t covered, as well as the cost of any additional services or supplies that may be needed. Additionally, it is important to understand the limits of your plan and make sure you are taking advantage of any special programs or discounts that may be available.

Medicare Advantage Plans

If you have a Medicare Advantage plan, it is important to understand the coverage and restrictions associated with it. These plans often have different requirements and limits than original Medicare, so it is important to check with your plan to understand what is and isn’t covered. Additionally, some Medicare Advantage plans may not cover physical therapy at all, so be sure to check with your provider first.

Supplemental Insurance

Supplemental insurance policies can help cover the costs of physical therapy services that are not covered by Medicare Part B. These policies can help cover the costs of deductibles, coinsurance, and other out-of-pocket expenses associated with physical therapy. Be sure to compare policies and read the fine print carefully to make sure you are getting the coverage you need.

Conclusion

Physical therapy can be an important part of recovering from injury or illness, managing chronic conditions, and improving overall mobility. Medicare Part B covers many physical therapy services, but there are some limits and restrictions to be aware of. Generally speaking, Medicare will cover up to 80% of the approved amount for each physical therapy session, but there may be limits on the number of sessions that are covered. Additionally, there may be additional expenses associated with physical therapy services that are not covered by Medicare. To get the most out of your coverage, it is important to understand what is and isn’t covered, as well as the limits of your plan. Additionally, supplemental insurance policies can help cover the costs of deductibles, coinsurance, and other out-of-pocket expenses associated with physical therapy.