Does Medicare Cover Physical Therapy?
Posted June 20, 2022
Outpatient physical therapy can be expensive without insurance, however with most health coverage plans it can be very affordable. For example, physical therapy is typically covered by Medicare. After your deductible is met, Medicare covers 80% of the approved cost of physical therapy. Importantly physical therapy can often save lots of other costs. Researchers in 2018 found that when physical therapy is used as first line treatment for lower back pain, patients are less likely to have to visit the Emergency Room or need advance imaging services (like an MRI), and reduce the probability of having an opioid prescription by 89%.
The process of figuring out your insurance coverage can be confusing, but it doesn’t have to be! This article will walk you through everything you need to know about Medicare coverage for physical therapy services.
Which Parts of Medicare Cover Physical Therapy?
Physical therapy is covered under Medicare Part B, which includes most physician services, both in the hospital and out of the hospital, as well as physical therapy services. With Medicare Part B, your physical therapy will be covered under the condition that your doctor deems it appropriate and decides that it is medically necessary. There are some exceptions to this situation, and every patient is different, so it is important to ask questions and make sure you are clear on the kind of treatment that your doctor recommends to you. Sometimes your doctor may recommend that you need treatment more often than Medicare covers or recommend an outpatient physical therapy clinic that does not accept Medicare.
In order to get the most out of your Medicare benefits when seeking physical therapy treatment, it is important to ask the right questions to your doctor or your physical therapist on your first day. There are a few important questions you can ask that can help you determine how much physical therapy will cost, and how much will be covered by Medicare. You should inquire about the exact items on your treatment plan and the cost of each test or service. You should also ask if your treatment plan includes any services that are not covered by Medicare. Another factor to consider is if you have any additional insurances that could help reduce the cost of your physical therapy alongside Medicare.
Understanding Medicare Advantage and Medicare Costs
In 2022 under Medicare part B, your deductible is $233, meaning that you are responsible for paying all physician, hospital, or physical therapy fees until they add up to this amount. After that point, Medicare will pay 80% of your healthcare costs, as long as the costs are less than or equal to the Medicare-approved amounts for that particular service or treatment. This means however, that if your doctor or physical therapist charges more than the amount that Medicare has approved, you may be responsible for more than 20% of the total cost of your treatment. Fortunately, Medicare does not place a limit on the total amount they will pay as long as the treatment is considered medically necessary.
In order for physical therapy to be considered medically necessary by Medicare, your doctor will need to provide documentation of their recommendation for physical therapy. After that, your physical therapist will evaluate you and determine whether you will benefit from skilled physical therapy services. If your problem is something that physical therapy can help with, your PT will provide detailed written documentation to Medicare of the services that are provided and why they are necessary. With this information, Medicare will pay for 80% of your physical therapy services, up to the pre-approved amount.
Finding a Physical Therapist
The first step to using Medicare for your physical therapy is getting a script for physical therapy from your doctor. Another important part of the process is making sure that your physical therapy clinic accepts Medicare. While searching for a physical therapist you should also compare costs and find out how much of your treatment will be covered by your Medicare. Finally, don’t be afraid to ask questions! Your doctor, physical therapist, and PT clinic staff are there to clear up any confusion and make sure you receive the best, most affordable care possible.
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