Physical therapy is one of the most commonly used rehabilitation services among Medicare beneficiaries, with millions of visits billed each year for conditions ranging from post-surgical recovery to chronic pain management. The good news: does Medicare cover physical therapy? Yes, Medicare Part B covers medically necessary outpatient physical therapy, and Part A covers PT during inpatient stays. The more nuanced reality involves cost-sharing, therapy thresholds, documentation requirements, and provider rules that every beneficiary should understand before starting treatment.
This guide breaks down Medicare’s physical therapy coverage, including what you will pay, how therapy caps work, and where Medicare Advantage fits in. For a broader overview of Medicare’s structure and benefits, visit our healthcare policy guide.
Medicare Part B Physical Therapy Coverage
Medicare Part B covers outpatient physical therapy when it is considered medically necessary and ordered by a physician or qualified healthcare provider. Coverage applies to a wide range of conditions, including:
- Post-surgical rehabilitation (joint replacement, spinal surgery)
- Stroke recovery and neurological conditions
- Chronic pain and musculoskeletal disorders
- Fall prevention and balance training
- Recovery from fractures and sports injuries
- Pulmonary rehabilitation for chronic lung conditions
The therapy must be provided by a Medicare-enrolled physical therapist or in a Medicare-participating outpatient setting such as a hospital outpatient department, skilled nursing facility outpatient unit, or physical therapist’s private practice. Home health physical therapy is also covered under Medicare’s home health benefit when you meet homebound criteria.
A physician or qualifying provider must certify the plan of care, and the therapy must aim to improve, restore, or maintain function. Medicare does not cover physical therapy solely for general wellness or fitness purposes.
Medicare Part A: Inpatient Physical Therapy
When you are admitted as an inpatient to a hospital or skilled nursing facility (SNF), Medicare Part A covers physical therapy as part of your inpatient care. In a SNF, Part A covers up to 100 days of skilled nursing and rehabilitation services per benefit period — including physical therapy — following a qualifying 3-day hospital stay.
Cost-sharing for SNF care under Part A includes:
- Days 1-20: $0 coinsurance (fully covered)
- Days 21-100: A daily coinsurance of $204.50 in 2026
- Days 101+: Not covered by Medicare
If you have a Medigap plan, it may cover the daily coinsurance for days 21-100. The PT you receive in a SNF is part of your overall rehabilitation plan and is not billed separately — it is bundled into the facility’s daily rate.
Therapy Thresholds and the KX Modifier
Medicare sets annual spending thresholds for outpatient therapy services. For 2026, the threshold for physical therapy and speech-language pathology combined is approximately $2,330. Occupational therapy has a separate threshold at the same amount.
Reaching the threshold does not mean coverage stops. Instead, once spending exceeds the threshold, your provider must include a KX modifier on claims certifying that continued therapy is medically necessary. Medicare will continue to pay for services above the threshold as long as medical necessity is documented.
There is also a higher threshold — approximately $3,000 — beyond which claims are subject to targeted medical review by Medicare contractors. At this level, additional documentation may be required to justify ongoing treatment. This does not mean coverage is denied, but claims are more likely to be scrutinized.
The elimination of hard therapy caps in 2018 was a major change for beneficiaries. Before that, Medicare imposed firm dollar limits on annual therapy spending, creating situations where patients needing intensive rehabilitation ran out of coverage mid-year.
Costs and Out-of-Pocket Expenses
For outpatient physical therapy covered under Part B, you typically pay:
- The Part B annual deductible: $257 in 2026
- 20% coinsurance of the Medicare-approved amount for each session after the deductible is met
A typical outpatient PT session costs $100 to $200 under Medicare’s approved rates, meaning your 20% coinsurance comes to roughly $20 to $40 per session. If you attend two sessions per week for eight weeks, your out-of-pocket total (after meeting the deductible) could range from $320 to $640.
Medigap plans often cover the 20% coinsurance, reducing your cost to $0 for covered sessions. Medicare Advantage plans may use different cost-sharing structures, such as flat copays per visit (often $20 to $40) instead of percentage-based coinsurance.
For a broader perspective on how Medicare cost-sharing affects total healthcare spending, see our healthcare costs guide.
Medicare Advantage and Physical Therapy
Medicare Advantage (Part C) plans must cover physical therapy at least as generously as Original Medicare. Many plans structure PT benefits with flat copays rather than coinsurance, which can make costs more predictable. Copays of $20 to $40 per visit are common.
Some Medicare Advantage plans require prior authorization for physical therapy beyond a certain number of sessions, which Original Medicare does not. If your plan requires prior authorization, your provider’s office typically handles the request, but delays can occur. Review your plan’s evidence of coverage to understand any visit limits, authorization requirements, or network restrictions.
Medicare Advantage plans also impose network requirements. Using an out-of-network physical therapist may result in higher costs or no coverage at all, depending on whether you have an HMO or PPO plan. Original Medicare allows you to see any Medicare-participating provider nationwide without network restrictions.
Home Health Physical Therapy
Medicare covers physical therapy provided at home through the home health benefit when you meet specific criteria. You must be homebound (leaving home requires considerable effort), under the care of a physician, and in need of skilled services including PT. A Medicare-certified home health agency must provide the care.
Home health PT is covered at 100% with no coinsurance under Medicare — one of the few services without cost-sharing. There is no limit on the number of sessions as long as you continue to meet the homebound and medical necessity criteria. This makes home health PT particularly valuable for beneficiaries recovering from surgery, managing progressive conditions, or dealing with mobility limitations.
Frequently Asked Questions
Does Medicare limit the number of physical therapy visits?
Medicare does not impose a hard limit on PT visits. However, annual spending thresholds apply. Once spending exceeds approximately $2,330 per year, providers must document that continued therapy is medically necessary. Coverage continues as long as medical necessity is supported.
Do I need a referral for Medicare-covered physical therapy?
Medicare does not require a referral from a primary care physician to see a physical therapist. However, a physician or qualifying provider must certify and periodically review your plan of care. Some Medicare Advantage plans may impose referral requirements, so check your plan’s rules.
Does Medicare cover physical therapy after knee replacement?
Yes. Physical therapy following knee replacement surgery is a covered benefit under both Part A (during inpatient recovery) and Part B (outpatient rehabilitation). Post-surgical PT is one of the most common uses of this benefit.
How much does physical therapy cost with Medicare?
After meeting the $257 annual Part B deductible, you pay 20% coinsurance per session — typically $20 to $40 per visit. Medigap plans may cover this coinsurance. Medicare Advantage plans often charge flat copays of $20 to $40 per visit instead.
Does Medicare cover physical therapy for chronic pain?
Yes, if the physical therapy is deemed medically necessary to improve, restore, or maintain function. Chronic pain conditions including back pain, arthritis, and neuropathy can qualify for coverage when a physician certifies the treatment plan. Understanding how Medicare handles related services like acupuncture can also help you weigh your pain management options.
The Bottom Line
Does Medicare cover physical therapy? Yes — and for most beneficiaries, it is one of the more accessible and well-covered rehabilitation services in the program. Part B handles outpatient PT with standard cost-sharing, Part A covers inpatient rehabilitation, and home health PT comes with zero coinsurance. The elimination of hard therapy caps means that beneficiaries needing intensive or extended treatment are no longer cut off at an arbitrary dollar amount. Focus on working with Medicare-enrolled providers, keeping up with documentation requirements, and understanding your specific cost-sharing obligations whether you are on Original Medicare or a Medicare Advantage plan.