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

Answered by 13 licensed agents

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.

Answered by Cynthia Nakaya on April 15, 2025

Agent Licensed in CA, AZ, CO, GA, MO & TX

Answered by Cynthia Nakaya Medicare Insurance Agent
Your own doctor will put in place "a plan of care". This decision depends upon the severity of your needs. For example. once "a 4 week plan" ends, if you still require more therapy, that same doctor can write added weeks so that in her/his opinion, you are very close to a recovery. So, your answer is AS MANY AS YOUR CONDITION REQUIRES.

Answered by Steven Bleicher on May 30, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent
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.

Answered by Timothy Brown on April 8, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent
Medicare Part B typically covers outpatient physical therapy, occupational therapy, and speech-language pathology when deemed medically necessary by your doctor or therapist.

If you have a Medicare Supplement or a Medicare Advantage plan, you can contact your broker/agent and they can verify your benefits.

Answered by Diana Garner on April 29, 2025

Broker Licensed in KY, FL, IN, OH & TN

Answered by Diana Garner Medicare Insurance Agent
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.

Answered by Michael Pyers on April 14, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent
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
First of all, Physical Therapy must be considered Medically Necessary. Usually not more than 10 visit are approved unless there is additional documentation and a written treatment plan with performance tracking by the physical therapist to justify the need. There is also a cap on the overall dollar amount that can be spent.

Answered by Katheryn Evans on May 20, 2025

Agent Licensed in WA, AZ, CA & 13 other states

Answered by Katheryn Evans Medicare Insurance Agent
Part A: Covers inpatient physical therapy in a hospital or skilled nursing facility.

Part B: Covers outpatient physical therapy, which is the most common type.

Medical Necessity: Medicare will pay for physical therapy that is deemed medically necessary to improve or maintain your health

Answered by Steven Maicus II on May 12, 2025

Agent Licensed in NY

Answered by Steven Maicus II Medicare Insurance Agent
There is no specific limit to the number of physical therapy sessions Medicare will cover or how much Medicare will pay toward physical therapy services. Medicare will cover all physical therapy that a healthcare professional considers medically necessary.

Answered by Fred Manas on May 7, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent
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
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
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.

Answered by Sam Silva on April 10, 2025

Broker Licensed in FL, GA, NJ & 7 other states

Answered by Sam Silva Medicare Insurance Agent
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

Tags: Coverage Medicare Part B

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