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There’s no limit on how much Medicare pays for your medically necessary outpatient physical therapy services in one calendar year. Get important info on occupational & physical therapy coverage. Learn about therapy caps, skilled nursing care, speech-language pathology services, more.
Section 53107 of the BBA of 2018 additionally requires CMS, using a new modifier, to make payment at a reduced rate for physical therapy and occupational therapy services that are furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs).
Medicare Parts A and B cover physical therapy considered medically necessary to treat an injury or illness, including managing a chronic condition like Parkinson’s disease or aiding recovery from a fall, stroke or surgery.
Medicare no longer limits how much it pays for your medically necessary outpatient physical therapy, speech-language pathology, and occupational therapy services in one calendar year.
Medicare Part B covers outpatient therapy, including physical therapy (PT), speech-language pathology (SLP), and occupational therapy (OT). Previously, there were limits, also known as the therapy cap, how much outpatient therapy Original Medicare covered annually.
Medicare pays for inpatient and outpatient physical therapy services, but it does not cover the full cost. An individual will usually need to pay a deductible and copayment.
What Does Medicare Pay For If You Need Physical Therapy? In terms of coverage, Medicare physical therapy benefits cover the actual visits with a physical therapist as well as treatments administered during these visits. Medicare does not, however, cover the cost of traveling to and from a visit.
What does Medicare pay for when it comes to physical therapy? The answer depends on how physical therapy is administered and where. In the majority of cases, physical therapy is covered by Medicare through Part B. To enjoy the Medicare benefits of Part B, you will need to meet your deductible, and a copay or coinsurance may apply.
Medicare can help pay for physical therapy (PT) that’s considered medically necessary. After meeting your Part B deductible, Medicare will pay 80% of your PT costs.
Is my test, item, or service covered? Learn about inpatient rehabilitation care coverage & when Medicare can help cover rehab care costs following surgery, serious illness, injury, more.