What physical therapy is covered by medicare?
Whether you’re a senior who needs to know what physical therapy is covered by Medicare or a person who is looking into getting physical therapy for the first time, it’s important to understand what the Medicare rules are for the treatment of your condition. Whether you’re in Part B or Part C, there are rules that apply to you. Here are a few of them:
Outpatient physical therapy
Whether Medicare will cover outpatient physical therapy depends on your situation. The amount of coverage will vary depending on the type of coverage you have, the cost of the service, and the provider.
Medicare Part B covers 80% of the costs for medically necessary outpatient physical therapy. However, Part B has a deductible. The deductible for 2022 is $233. In addition to the deductible, beneficiaries will have 20% coinsurance.
Medicare Part A covers inpatient rehabilitation, or physical therapy, at a rehabilitation hospital. This service is usually ordered by a doctor when a patient has a serious injury. It may also be ordered as a preventive service.
Part B of Medicare also covers outpatient occupational therapy and speech-language therapy. This service may be done in the doctor’s office, at a rehabilitation center, or at home. However, it is important to note that Medicare does not cover physical therapy performed by non-physician practitioners.
Some private insurers’ Medicare Advantage (MA) plans have expanded their coverage. Some plans may require prior authorization, or require a referral, to receive physical therapy.
Telehealth visits for physical therapy
During the COVID-19 pandemic, telehealth visits for physical therapy are a lifesaver for many Americans. While the telehealth technology is certainly an improvement over the old days, Medicare is not paying for the full range of telehealth services.
The American Medical Association is calling on Congress to extend telehealth flexibility and expand the scope of telehealth services covered under Medicare. In the 117th Congress, several bills have been introduced that would assess the benefits and impacts of expanded telehealth services, and make them permanent. Currently, Medicare coverage for these services is temporary under 1135 waiver authority. The COVID-19 Public Health Emergency Waivers may expire in 2021.1 However, the Centers for Medicare & Medicaid Services (CMS) has temporarily extended coverage for expanded telehealth services through December 31, 2023.
Telehealth services include video sessions, messaging, and phone calls. They can be used by any healthcare provider. Telehealth practitioners include clinical social workers, physician assistants, advanced practice registered nurses, clinical psychologists, and occupational therapists.
Part B deductible
Until recently, Medicare had a limit on how much physical therapy it would pay for in a given year. For example, it used to cap outpatient therapy payments at $2,150. The government removed this cap in 2018.
Medicare Part B covers physical therapy services when they are considered medically necessary. It also pays a portion of the cost for durable medical equipment. However, copays still apply.
Part B also covers occupational therapy. This is because physical therapy helps people maintain mobility and improve coordination. It may be provided at home, in a clinic, or in an outpatient rehabilitation facility.
Original Medicare Part B pays 80% of the cost of outpatient physical therapy after the $203 deductible. Medicare Part A covers inpatient therapy, too. However, inpatient physical therapy is only covered for the duration of your hospital stay.
Medicare also pays for telehealth services. These include the management of prostheses, orthotics, and gait training. It also expanded its coverage of telehealth services during the COVID-19 pandemic.
Depending on the health condition of the person receiving physical therapy, Medicare may cover some or all of the cost. The person may have to pay for some or all of the cost. The cost of physical therapy may range from $75 to $350 per session.
Medicare covers medically necessary physical therapy in the office, hospital, and skilled nursing facility. It also covers preventive services to prevent illness. It may also cover therapy services provided at home.
If Medicare covers a patient’s therapy, it pays 80% of the cost after the patient has met his or her deductible. Medicare does not limit how many therapy sessions a person can receive in a year. However, there are limits on how much Medicare will pay for speech-language pathology services.
Medicare does not pay for physical therapy services that are not medically necessary. It may also require additional documentation. It is important for the patient to understand how much he or she is responsible for.
Get the physical therapy you need in Our Area!
To provide the long-term support you require, we use the most skilled and experienced healthcare professionals, adaptive exercises, evidence-based research, as well as innovative equipment. Our clinic empowers and strengthens communities. It also gives hope. If you are in the area, call us today for more information about physical therapy.
If you are interested in exploring our specializing in telehealth physical therapy treatment options and corrective exercise solutions, visit our website for more information. To get in touch with us, please visit our contact page. We look forward to helping you achieve your health and fitness goals at Fluid Health & Fitness.