According to Medicare, upon meeting your Part B deductible, Medicare will cover 80 percent of medically necessary physical therapy costs, with no restriction on the amount of outpatient physical therapy coverage.
APTA defined MEDICALLY NECESSARY PHYSICAL THERAPY SERVICES, “physical therapy is considered medically necessary as determined by the licensed physical therapist based on the results of a physical therapy evaluation and when provided for the purpose of preventing, minimizing, or eliminating impairments, activity limitations, or participation restrictions.” Furthermore, therapy treatment is considered medically necessary “if the type, amount, and duration of services outlined in the plan of care increase the likelihood of meeting one or more of these stated goals: to improve function, minimize loss of function, or decrease risk of injury and disease.”
Medicare Part B may cover the cost of outpatient physical therapy if you obtain the following services:
- At medical offices
- With privately practicing physical therapists
- At hospital outpatient departments
- At outpatient rehabilitation centers
- At skilled nursing facilities (when Medicare Part A doesn’t apply)
- At home (using a Medicare-approved provider)
What are the Medicare Therapy Threshold Limits for 2022?
When an injury or disease affects your capacity to function, Medicare covers evaluation and therapy to restore or maintain present function, as well as to prevent further decline. You pay 20% of the Medicare-Approved Amount, and the Part B deductible applies. You can have as much physical therapy as is medically necessary each year.
However, effective January 1, 2022, the current Medicare physical therapy threshold limits are:
- $2,150 for combined physical therapy and speech-language pathology services.
- $2,150 for occupational therapy services.
- $2,150 for PT and SLP services combined, and
- $2,150 for OT services.
It is possible that your doctor or another healthcare professional, such as your PT, will recommend that you receive services more frequently than Medicare covers. Alternatively, they may prescribe services that are not covered by Medicare. If this happens, you may be required to pay a portion or the entire cost of the treatment. You may inquire about specific services to ensure you understand why your doctor or PT is proposing them and whether or not Medicare would cover the costs of those services.
At Cadence Physical Therapy, we let our patients know the cost of their treatment upfront. We can also ensure there’s no double booking and no surprise bills. Cadence Physical Therapy being a private clinic, has a higher reimbursement rate compared to hospital or in-network physical therapy clinics.