Does Medicare cover physical therapy?
Fully, as long as it's medically necessary, and that phrase is doing all the work. Here is what Medicare pays, what the famous 'therapy cap' actually is now, and why the plan you're on matters more than the coverage rule.
Yes. Medicare Part B covers outpatient physical therapy, occupational therapy and speech-language pathology when a doctor or therapist certifies it's medically necessary and you're under a plan of care. You pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026); a Medigap policy pays that 20%. There has been no annual cap since 2018. The figure you'll see quoted, $2,480 for 2026, is a threshold, not a limit: once your physical therapy and speech therapy charges pass it in a year, the therapist adds a code confirming the care is still medically necessary, and coverage continues; claims above $3,000 can be reviewed. Therapy in a hospital, skilled nursing facility or through home health is covered under those benefits instead. Medicare Advantage plans cover the same therapy but usually with a copay per visit, an in-network requirement and prior authorization, which is where the experience differs most.
Where therapy is covered, and under which part
- Outpatient therapy at a private practice, hospital outpatient department or rehabilitation clinic: Part B, 20% after the deductible.
- Inpatient rehabilitation or hospital stay: Part A, under the hospital deductible ($1,736 in 2026).
- Skilled nursing facility after a qualifying three-day hospital stay: Part A, days 1–20 at $0, days 21–100 with a daily coinsurance, up to 100 days per benefit period.
- At home while homebound: the home health benefit, at $0 for the services (home health care).
The threshold that used to be a cap
From 1997 to 2017 Medicare capped outpatient therapy at a yearly dollar amount, with an exceptions process that most people never navigated. The Bipartisan Budget Act of 2018 repealed the cap. What's left: when your combined physical and speech therapy charges pass the year's threshold ($2,480 in 2026; occupational therapy has its own $2,480), the therapist adds the KX modifier to claims, attesting that the care is medically necessary and documented. Coverage continues. Above $3,000, Medicare can target claims for review, which is the provider's problem to document, not yours to pay. In practice: no one should be told "Medicare has stopped covering your therapy" because of a dollar amount.
Original Medicare versus Advantage on a long course of therapy
This is where the two routes diverge most in real life. Under Original Medicare with a Medigap Plan G, thirty visits after a knee replacement cost you the $283 deductible and nothing more, at any therapist who takes Medicare, with no authorization. Under an Advantage plan, thirty visits at a $30 copay is $900, at an in-network clinic, often after prior authorization and periodic re-authorization, and if the plan decides you've plateaued, the appeal is yours to fight. Advantage plans have a yearly out-of-pocket maximum that caps the damage, and many people never use much therapy; but if joint replacements, a neurological condition or a fall are realistic for you, it belongs in the comparison. Medigap · Medicare Advantage · how to choose.
Related
Chiropractic is covered far more narrowly than physical therapy; home health covers therapy at home at no cost when you're homebound. Ask about your plan's therapy rules before a scheduled surgery, not after.
- Physical therapy (Medicare.gov) — Part B, 20% after deductible; no cap; threshold
- Therapy services, calendar year 2026 updates (CMS) — $2,480 KX modifier threshold; $3,000 medical review threshold
- Jimmo v. Sebelius settlement (CMS) — maintenance therapy is covered
- Medicare costs 2026 (Medicare.gov)
Common questions
Short answers to what people ask before they call.
How many physical therapy visits does Medicare allow?
There's no visit or dollar cap. Congress removed the therapy caps in 2018. What remains is a threshold ($2,480 for physical therapy and speech therapy combined in 2026, and a separate $2,480 for occupational therapy) above which the therapist must attach a modifier confirming medical necessity, and a $3,000 level above which Medicare may review claims. Care continues as long as it's needed and documented.
What do I pay for physical therapy with Medicare?
Under Original Medicare, 20% of the Medicare-approved amount per visit after the Part B deductible ($283 in 2026); a Medigap Plan G pays the 20%, Plan N charges up to $20 per visit instead. Under an Advantage plan, the plan's therapy copay per visit (commonly a fixed dollar amount) at an in-network provider, often after prior authorization, up to the plan's yearly out-of-pocket maximum.
Do I need a doctor's referral?
Medicare requires a plan of care certified by a doctor or other qualifying practitioner, and re-certified every 90 days. New York allows direct access to a physical therapist for a limited period without a referral, but Medicare still needs the certification for payment, so the therapist will get it signed.
Is therapy covered if I'm not improving?
Yes, if skilled therapy is needed to maintain your function or slow decline (the Jimmo settlement, 2013). Medicare can't deny therapy just because you've plateaued; it can deny therapy that doesn't require a skilled therapist's involvement.
Therapy on the calendar?
A knee replacement, a stroke, a fall: therapy costs differ sharply between Original Medicare with Medigap and an Advantage plan. I'll show the numbers for your plan and the ones in your county.