Medicare is a government-run health insurance program that covers millions of Americans. It can be difficult to determine whether or not physical therapy is covered by Medicare. As far as the rules and regulations can change from year to year. In this blog post, we will explore whether or not physical therapy is covered by Medicare in 2022. As well as answer some common questions about the program.
Here is a Little Side Note
You can access your physical therapy benefits through Original Medicare or your Medicare Advantage Plan. Medicare no longer limits how much physical therapy you can get. However it requires ongoing written evidence that it is still helpful and necessary for you.
You can receive physical therapy in an inpatient setting like the hospital or a skilled nursing facility. In addition to an outpatient setting like a therapist’s clinic. You may be eligible to receive physical therapy at home. Or at an outpatient service center. Physical therapy is covered under Medicare Parts A and B, as long as it is prescribed by a physician. As well as by a non-physician practitioner and is deemed medically necessary to treat your condition.
Is Physical Therapy Valuable?
Yes! Research has shown that physical therapy can help improve pain, function, and quality of life for people with various conditions. Physical therapy can also help prevent further decline in function and may reduce the need for surgery or other invasive treatments. If you are considering physical therapy, be sure to discuss all of your options with your doctor to determine what is best for you.
What Are the Coverage Limits?
Medicare will cover 80% of the cost of physical therapy services after you have met your Part B deductible. You may be responsible for a 20% coinsurance, as well as any applicable copayments or deductibles. If you have a Medicare Advantage Plan, your coverage may be different. Be sure to check with your plan provider to find out what is covered.
Medicare Covers
Medicare covers physical therapy as skilled service. Whether you receive physical therapy (PT) at home. Or if you get it at a facility or hospital. Even if it is at a therapist’s office.
- PT must always be medically necessary for Medicare to provide coverage. That means it is a treatment for your condition that meets accepted standards of medicine.
- There must always be a physician or non-physician practitioner (like a physical therapist) to certify you need to start PT.
- You must have an ongoing medical need for PT to continue.
- You must receive PT from a provider who participates in Medicare.
Medicare will cover physical therapy under either Original Medicare Part A or Part B or a Medicare Advantage Plan. Your coverage and how much you pay depends on your plan, your particular circumstances, and where you receive your therapy.
Follow the rules for Medicare when it comes to physical therapy. The burden of proof that you are eligible to receive your physical therapy benefits lies with the suppliers and providers of therapy. There are rules about billing codes and documentation that the facility, therapist, or agency must follow. Can bill one part of Medicare at a time. Make sure you understand what your coverage looks like and how much you may need to pay, especially if you receive physical therapy in different settings.
In-Home Physical Therapy
Medicare Part A covers in-home physical therapy as a home health benefit under the following conditions:
- Your physician must certify the physical therapy services as medically necessary.
- Physical therapy is part of your home health plan of care that details how many visits you need and how long each will last.
- A qualified homebound therapist provides services.
- You must be homebound; that is, you can only leave your home with considerable difficulty and require assistance to do so.
- You must receive your home health services, including physical therapy, from a Medicare-approved home health agency.
Medicare Part B covers in-home physical therapy as an outpatient or preventive service in the same way it covers physical therapy in an office or clinic. Services must still be medically necessary, but the benefit of home visits is that the physical therapist can evaluate you and prescribe exercises that apply to your home environment. Part A does not require the patient to be home-bound.
In Closing, as you can see, there are a few things to consider when it comes to Medicare and physical therapy. Be sure to discuss your options with your doctor or therapist to ensure that you are getting the coverage that you need. Also, you can call us for assistance anytime.