Good Morning,

There are always so many questions regarding Physical, Occupational and Speech therapy with Medicare.  Here are some answers taken from the Medicare website:

This article was updated on: 11/16/2016

One of the questions beneficiaries ask is whether Medicare covers physical therapy. You may have heard about the Medicare physical therapy “cap.” Medicare Part B helps pay for medically necessary services, generally up to a certain limit or cap as described below.

Physical therapy involves examination, evaluation, and treatment to improve your ability to move or restore certain aspects of your physical well-being, according to the Mayo Clinic. Doctors sometimes order physical therapy after surgery to help you recover and regain your mobility, but might order these services in other situations where physical therapy services might improve your ability to function.

Where will you receive physical therapy services?

If you receive physical therapy services as part of Medicare-covered home health care, Medicare Part B may cover the full cost of the therapy. Typically these covered services are part-time or only received occasionally.

If your Medicare-assigned doctor decides that physical therapy is medically necessary outside of home health care, Medicare Part B will cover 80 percent of the Medicare-approved costs of outpatient physical therapy, occupational therapy, and speech-language pathology, until the limits are reached. The Medicare Part B deductible also applies.

What are Medicare physical therapy caps?

Medicare limits on these services are called “therapy cap limits” – meaning simply that Medicare will only cover up to these limits as described below. The therapy cap limits for 2016 are as follows:

  • Physical therapy services and speech-language pathology services combined – $1,960
  • Occupational therapy – $1,960

If you reach your therapy cap limits and your doctor recommends that you continue with the treatment, you can ask your therapist for an exception so that Medicare will continue to pay for your therapy. The therapist must provide documentation that these services are medically reasonable and necessary, including services after the therapy cap limit is reached.

In some situations, you might want to get physical therapy even if it’s not considered “medically reasonable and necessary” by Medicare. Before you get physical therapy that’s not medically reasonable and necessary, your therapist is required to give you a written document called an “Advance Beneficiary Notice of Noncoverage” (ABN). Medicare Part B won’t pay for these services, but the ABN lets you decide whether to get them. If you decide to get physical therapy, the ABN requests your agreement to pay since Medicare will not cover services that are not medically necessary.

On the other side of this, there is private pay physical therapy!!!!!  At Integrative Therapy and Wellness, LLC, our team has many years of experience to assist in home therapy patients  Engage in Life and Engage in Wellness.  Our team will provide a full Physical Therapy assessment where ever the patient is, home, nursing facility, retirement community or assisted living home.  Our treatment plan will help your loved one with mobility exercises, stimulation and to Engage in Life and Engage in Wellness.  For information on our services contact Kim Jacob at

I hope this article helps you understand the complex Medicare guidelines.

Thank you for reading,

Kim Jacob

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