My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?

Question

Cynthia Nakaya · Accepted Answer

The number of physical therapy visits you get depends on what your doctor says. If the therapy is deemed medically necessary, Original Medicare will pay. 

However, if you have a Medicare Advantage plan and they deny the therapy, appeal the decision. MA coverage is required to be at least as good as Original Medicare so make sure your plan pays for what your doctor says you need.

Timothy Brown · Answer

It depends on the insurance plan.  Medicare advantage plans require prior authorization or pre-certification. called prior authorization or pre‑certification. Note: Members must meet the Centers for Medicare & Medicaid Services (CMS) criteria for medically necessary skilled care 
to be covered. Medicare Supplements/Medigap plans do not require prior authorization or have restrictions on visits.

Michael Pyers · Answer

It is determined by medical necessity that the patient requires.  However, after around $2400 of therapy the physician must submit proof that continued therapy is necessary.

Rene Casanova · Answer

The best resource at your disposal is the Medicare "What's Covered" App you can download from the Apple store. Just type in What's Covered in the search feature and download it. It'll answer all of your questions on how Medicare covers medical conditions.

Answered by Rene Casanova on April 14, 2025

Broker Licensed in TX

Answered by Rene Casanova Medicare Insurance Agent

Steve Brauer · Answer

Medicare, or Medicare Advantage plans will cover "medically necessary" physical therapy. With Orginal Medicare, its covered under the Part B, and then you either have the remaining 20% covered with a MediGap plan or you'd pay a copay with your Medicare Advantage plan

Answered by Steve Brauer on April 16, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Vachik Chakhbazian · Answer

You need to call me as your agent to review your Medicare SOB and let you know your options. coverage is based on medical necessity, not a set number of visits, and there is no longer a therapy cap for Original Medicare.

Answered by Vachik Chakhbazian on April 9, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Mel Stevens · Answer

Every plan is different. Details regarding items such as how many physical therapy sessions are covered and co-pay charges if any should be specified. If the summary of benefits is not available, call the customer service number on the back of your insurance provider card. When discussing with a customer service representative you can also request to have the insurance provider e-mail or send a copy of your summary of benefits upon request.

Answered by Mel Stevens on April 9, 2025

Broker Licensed in AZ

Answered by Mel Stevens Medicare Insurance Agent

Sam Silva · Answer

Review Medicare Summary Notice – This document shows what Medicare has paid and what you may owe.
Check Supplement or Advantage Plan summary of benefits– If you have a Medicare Advantage plan or Medigap, coverage rules may vary.

My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?

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My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?

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