Regardless of if it is for a temporary or chronic condition, physical therapy can yield amazing results. Does Medicare cover physical therapy? The amount of services Medicare will cover has its limits.
Medicare Part B covers medically necessary outpatient physical and occupational therapy, and speech-language pathology services. If a given service is not considered medically necessary, your therapy provider must give you a notice, called an “Advance Beneficiary Notice of Noncoverage” (ABN), before providing these services. This allows you to make a decision regarding whether or not to continue with the therapy plan.
After you’ve paid the Medicare Part B deductible ($166 in 2016, $183 in 2017), Medicare covers 80% of therapy services up to the Medicare physical therapy cap. (The remaining 20% can be covered by a Medicare Supplement plan.) This cap changes every year and in 2016 it is $1,960 for physical therapy and speech-language pathology services combined. For any occupational therapy services, beneficiaries are allowed $1,960 of coverage.
What happens if you reach one of the therapy caps in the middle of the year? Medicare allows for exceptions so that you may continue therapy. This involves you working with your therapy provider to indicate to Medicare that the ongoing therapy is medically necessary. According to Medicare, therapy is generally allowed to continue for the remainder of the year if deemed necessary.
TIP: Always err on the side of over-communicating with your provider when planning therapy sessions. Be sure they are aware of your insurance setup and how the process works should you hit the therapy cap.