(We updated this post on April 3, 2019)
Physical therapy is a benefit that many people don’t plan for. Yet every year Medicare spends millions on physical therapy for Medicare beneficiaries. Here’s what you need to know about Medicare physical therapy coverage.
Does Medicare Cover Physical Therapy?
Yes, Medicare Part B helps to pay for outpatient physical therapy benefits as well as occupational therapy and speech-therapy. Services can be provided by therapists in private practices, outpatient hospital departments, and skilled nursing facilities. Beneficiaries can also seek treatment from therapists who are part of rehabilitation agencies. This gives you great choices for your care.
In the past, there were certain annual limits that applied to these services. We call these Medicare Physical Therapy Caps.
In 2018, the Centers for Medicare and Medicaid Services set the caps at $2,010 for speech therapy and physical therapy combined, with an additional $2,010 for occupational therapy. However, in 2019, Medicare has done away with therapy spending caps.
Exceptions to Medicare Physical Therapy Coverage
With this change to Medicare, your physical therapist can continue to treat you beyond the soft caps. However, be away that Medicare could do a review to make sure the physical therapy is still medically necessary.
If Medicare decides that the therapy you are receiving is no longer medically necessary, they could decide not to allow any further physical therapy that year. Be sure to ask your therapist to document the medical necessity of every visit you have with them.
(Please note that these items apply for people who are on Original Medicare. Individuals covered under a Medicare Advantage plan will have different coverage as outline by their plan’s Summary of Benefits.)
How to Know If You are Covered for Physical Therapy
If a Medicare provider gives you a service that may be considered not to be medically necessary, they must notify you, as we mentioned above. The provider will give you an Advance Beneficiary Notice that explain the chance non-coverage. You’ll then have the choice to continue, possible at your own expense, or cancel.
Find a Plan With The Right Coverage
Figuring out your Medicare benefits is not always easy. Boomer Benefits provides a Client Service Team to help you with understanding and managing claims forms and even exceptions or appeals. Contact us today to learn how you can benefit from our team of experts!