Does Medicare Cover Physical Therapy After An Accident or Surgery?

by David Bynon, last updated

Does Medicare Cover Physical Therapy?

Does Medicare Cover Physical Therapy?

If you’re covered by Medicare and have an illness or injury that requires physical therapy, you may wonder, “what does Medicare cover?” More specifically, you’ll likely want to know does Medicare cover physical therapy?

In this article, we will look at Medicare coverage for physical therapy and guide you through the process of verifying your benefits if you visit a doctor of physical therapy.

Check Your Coverage

If you are covered by Original Medicare, your benefits will be different than coverage under a Medicare Advantage plan. Medicare Part B does have benefits for outpatient medical services and therapies. With a Medicare Advantage plan, you have all the coverage of Parts A and B, plus additional services and benefits.

Does Medicare Cover Physical Therapy?

Yes! Under Medicare Part B, which covers most outpatient services, physical therapy is covered if it is medically necessary. The laws governing Medicare no longer set a limit on how much Medicare pays for physical therapy in a calendar year.

If you have a Medicare Advantage plan, you may be required to use an approved physical therapist in your plan’s network.

How Much Will I Have To Pay?

Medicare is a co-insurance program. That means you pay 20 percent of the cost after you meet your deductible. Medicare pays for up to 80 percent of the approved amount.

In 2020, Medicare covers up to $2,080 for physical therapy before your doctor must specify your care is medically necessary. And since Medicare pays 80 percent of this cost, your portion is $416.

If you have a Medicare Advantage plan, you will likely pay a co-pay instead of the 20 percent co-insurance. Co-pays vary by plan. If you have a Medicare Supplement plan to help cover some of the gaps in your Original Medicare, what you pay will depend on the plan you have.

The specific amount you will pay for physical therapy services will depend on the type of Medicare plan you have, how much your doctor charges for their services, and the type of facility where the service is provided. Always discuss costs with your healthcare provider, so you have a clear understanding of your financial responsibility.

Where Can I Receive Physical Therapy?

Medicare benefits are available for therapy provided at the office of your doctor or physical therapist. Comprehensive Outpatient Rehabilitation Facilities, Skilled Nursing Facilities, and some home health agencies are covered by Medicare.

How Do I Know If My Therapy Is Medically Necessary?

Medicare defines medically necessary as “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” If your provider is a professional physical therapy practitioner, they can help you determine if Medicare covers your therapy services.

Suppose your therapy is determined by Medicare not to be medically necessary. In that case, you or your doctor will receive an Advanced Beneficiary Notice of Non Coverage (ABN). You do have the option of appealing this decision.

Find the Right Option For You

Does Medicare cover physical therapy after an accident or surgery? Yes, it does. As long as the physical therapy is medically necessary, it will be covered by Original Medicare or a Medicare Advantage plan.

Determining your Medicare benefits can be tricky, but MedicareWire offers plenty of help and Medicare resources to answer your questions. Check out the rest of our site for important information about Medicare Advantage plan options for your needs and budget.

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