Does Medicare Cover Physical Therapy?
Physical therapy helps elders recover from injuries and illnesses, manage chronic conditions, and prevent future injuries. It can be an essential component of health care for older adults.
Medicare covers physical therapy (PT) when it is medically necessary to treat a disease or injury, according to Medicare.gov. Those who qualify for Medicare because of age or disability could receive covered physical therapy services.
What Is Physical Therapy?
Physical therapy helps people improve their balance, movement, muscle strength, joint mobility, and overall health. Highly trained professionals specializing in activity and exercise prescribe exercises to help patients enhance their physical capabilities and control pain.
Older adults can require physical therapy for several reasons. Following a health incident, such as a neurological event, surgery, or a fall, physical therapy can help a patient restore mobility. For instance, a physical therapist could help a stroke patient regain movement. WebMD reports that physical therapists can also help older adults with such conditions as osteoporosis, balance problems, certain cancers, and incontinence.
PT helps people recover from injuries and manage chronic conditions, while also reducing the risk of future injuries. In addition, it may help prevent injuries and mitigate functional declines associated with aging, according to the National Council on Aging.
The Benefits of Physical Therapy
In treating and preventing injuries, physical therapy can benefit many older adults, as it helps restore and maintain physical health. PT may:
- Reduce pain. After undergoing treatment, you may need less pain medication. Research shows that physical therapy significantly reduces patients’ long-term opioid use.
- Expedite recovery. According to Medicare.org, physical therapy can speed up recovery following an injury or surgical procedure. It can also reduce the need for future surgeries.
- Preserve your autonomy. Physical therapists can help seniors to maintain their independence. With physical therapy, older adults may continue to perform activities of daily living on their own, such as showering, using the toilet, and dressing.
- Improve mobility. Per St. Luke’s Health, PT can help older adults continue to move around without a cane or walker. For people with Parkinson’s, prescribed PT exercises can help increase mobility as well. As John Hopkin’s Medicine reports, physical therapists can help patients reinforce movements that the disease affects.
- Lower your risk of falling. Seniors can reduce their risk of falls with PT. According to the Centers for Disease Control and Prevention, one in four Americans over 65 suffers a fall every year. Improving flexibility, strength, and balance can help older adults avoid falls.
When Does Medicare Pay for Physical Therapy?
Given the benefits of physical therapy, Medicare recipients might seek services to treat injuries, manage chronic conditions, and maintain physical health.
Medicare helps cover the cost of PT in certain circumstances. A doctor or another health care provider, such as a nurse practitioner, clinical nurse specialist, or physician assistant, must certify that the patient needs physical therapy.
Qualifying beneficiaries can get covered PT services via Medicare Part A or Part B.
This includes PT in any of the following:
- a doctor or therapist’s office
- a hospital outpatient department
- a skilled nursing facility providing outpatient care
Medicare Part B also covers in-home PT when an individual does not receive Part A home health benefits.
Once individuals pay the Part B deductible, which is $226 in 2023, Medicare covers outpatient PT. When coverage kicks in, beneficiaries are responsible for 20 percent of the Medicare-approved payment. This may include outpatient occupational therapy, physical therapy, and speech-language pathology.
Be sure to ask your health care provider any questions you may have about coverage for PT services or related tests. Speak with an elder law attorney in your area as well as to learn more about Medicare.
Last Modified: 02/02/2023