Does insurance cover physical therapy?
In almost all cases, physical therapy will be covered by insurance if the services are deemed “medically necessary.” Generally, major healthcare providers consider physical therapy to be medically necessary if it:
Has been prescribed by a physician
Improves the patient’s functioning in a reasonable period of time
Outlines attainable, quantifiable goals for the patient
Requires the skills of a licensed, trained physical therapist (as opposed to another type of medical specialist)
For instance, a patient may receive physical therapy to regain function after a stroke, slow physical deterioration due to illness, or improve motor function after surgery. In all these cases, physical therapy likely would be considered medically necessary.
Physical therapy isn’t considered medically necessary if:
The patient’s condition isn’t expected to improve in response to therapy
The patient can gradually regain function without therapeutic services
Treatment will not lead to medical improvement
For example, if a patient received physical therapy to return to a sport, such treatment is not considered a medical necessity. Additionally, if a physician expects a patient to regain function as a natural part of the healing process, physical therapy will not be considered medically necessary.
Coverage for assistive equipment or specialty PT procedures may vary based on your insurance plan. For more details on what’s covered in your plan, reach out to your insurance provider directly. You can also discuss coverage with your physical therapist, as they’re often well-versed in coverage options.
Learn More: How to Compare Medicare Advantage and Get the Best Plan
In the majority of cases, employer-sponsored health plans cover physical therapy. It’s important to find a therapist in your insurance network, which will reduce your out-of-pocket costs. Visit your insurance company’s website, which often includes a database of in-network healthcare providers.
Read your policy carefully to determine how many sessions are covered in a calendar year. For example, Kaiser Permanente limits physical therapy coverage to 40 sessions per year. If you need more sessions, you’ll need a letter from your physical therapist outlining the need for further services, which can help certify additional coverage.
Does Medicare cover physical therapy?
Medicare Part B covers outpatient rehabilitation, which includes physical therapy. To qualify for coverage, a physician or non-physician practitioner must certify the physical therapy treatment as medically necessary. To prove medical necessity, documentation must outline how physical therapy will improve the patient’s physical functioning or slow physical deterioration.
Medicare guidelines state that the duration of these services must be reasonable. Your physical therapist will perform an initial evaluation to determine the amount and frequency of therapy sessions. Medicare recipients will still have to pay the annual Part B deductible, which was $233 in 2022.
Will Obamacare cover physical therapy?
Rehabilitative and habilitative healthcare are covered under the Affordable Care Act, which means at least part of your physical therapy will be paid if you have a plan from the Health Insurance Marketplace. Depending on the state you’re enrolled in, the number of physical therapy sessions that are covered in a year may be capped.
Check Out: What Is the Affordable Care Act?
Does Medicaid cover physical therapy?
Medicaid covers physical therapy in 41 states, according to a Kaiser Family Foundation survey of all state Medicaid directors. In states where Medicaid covers physical therapy, 25 have limitations on services.
Keep in Mind: If a state considers a type of healthcare service to be an “optional benefit,” it may still be covered. However, there may be stricter eligibility requirements or fewer sessions covered. Contact your state Medicaid agency for more information.