Medicare and Physical Therapy Inclusions
Medicare Part B encompasses the inclusion of outpatient physical therapy, occupational therapy, as well as speech-language pathology services. These rehabilitative services are accessible through private therapist offices, outpatient departments of hospitals, and skilled nursing facilities.
What Are the Coverage Boundaries for Physical Therapy Under Medicare?
As of the year 2019, the imposition on therapy expenditure limits has been lifted by Medicare. Consequentially, there are no longer any predefined boundaries to the amount of physical therapy sessions Medicare will approve coverage for.
Expected Out-of-Pocket Expenses for Physical Therapy Under Medicare
In instances where you hold Original Medicare and seek physical therapy, it may be necessary to pay off your Part B deductible first. Subsequently, Medicare is responsible for 80% of the therapy expenses, while supplemental Medigap policies may alleviate the burden of the remaining 20% of your coinsurance costs, should you have enrolled in such a plan.
It is salient to note that Medicare will only reimburse sessions of physical therapy that are deemed medically essential. In the event that a Medicare-certified provider offers a service that may not qualify as medically essential, they are obliged to alert you. An Advance Beneficiary Notice will be presented to you, detailing your options regarding services not covered. Should you elect to forgo the service, you have the liberty to proceed but will be financially liable.
