Does Medicare Cover Physical Therapy?

Medicare pays for physical therapy to help you recover from a fall, surgery or illness, and to keep the strength you have. If stairs or getting up from a chair have gotten harder, it's worth asking your doctor about therapy. A doctor, nurse practitioner or physician assistant must say you need it and sign your therapy plan. What you pay depends on where you get it.

Medicare pays if

• A doctor, nurse practitioner or physician assistant signs your therapy plan.
• You need a licensed therapist's skill to do the exercises safely.
• The therapist or clinic takes Medicare.

Not sure Medicare will pay? Ask anyway, because the clinic can check before your first visit. Or a Pair Team advocate can help you sort it out.

What you pay for physical therapy in 2026

For the nursing facility rules, like the 3-day stay, see what Medicare covers after a hospital stay.

Is there a limit on how much physical therapy Medicare covers?

No, Medicare has no limit on how much it pays for therapy you need in a year, Medicare.gov says. The old cap ended in 2018, when Congress passed the Bipartisan Budget Act. Some websites still say there's a cap, but it's gone.

Medicare still has to agree the therapy is medically needed. Your doctor or nurse practitioner signs the plan again at least every 90 days if you keep going.

What is the $2,480 therapy threshold in 2026?

The therapy threshold is a checkpoint, not a cap. The Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare, sets it. It's $2,480 in 2026 for physical therapy and speech therapy added together. Occupational therapy has its own $2,480. The amount counts Medicare's price for your visits from January 1, and it goes up a little each year.

Once you pass it, your therapist adds a code called the KX modifier to each bill. It tells Medicare you still need therapy and your records show why. Past $3,000, Medicare may review your records, but not every case gets reviewed.

Two rules protect you. First, if the clinic leaves off the code and Medicare says no, the clinic pays. You'd owe only if you had signed a form called an Advance Beneficiary Notice first. Second, the clinic shouldn't ask you to sign that form just because you passed $2,480. It should ask only if it thinks more therapy is no longer medically needed.

Does Medicare pay for therapy that keeps me from getting worse?

Yes, Medicare pays for skilled therapy that keeps you from getting worse, like therapy to keep your strength or slow a decline. This rule comes from a 2013 court settlement called Jimmo v. Sebelius. Coverage depends on whether you need a therapist's skill, not on whether you can improve, CMS says. If you can do the exercises safely on your own or with a helper, Medicare may stop paying.

If a clinic says "you have plateaued, so Medicare will not pay," ask it to check the Jimmo rule. If Medicare says no, see how to appeal a Medicare denial.

Can I get physical therapy at home?

Yes, you can get physical therapy at home in two ways. If leaving home is hard, home health sends a therapist to you, and you pay $0. See what Medicare pays for home health care. If you can get out, some outpatient therapists make house calls, and you pay the usual 20%. You can't use both at once.

How to start physical therapy with Medicare

1. Talk with your doctor. Say what's hard, like stairs, walking or getting up from a chair, and ask if therapy could help.
2. Find a therapist who takes Medicare. Ask your doctor for names, or see finding a provider who takes Medicare.
3. Get checked so the therapist can set goals and how often you'll come. Then your doctor or nurse practitioner signs the plan.
4. Ask what you'll pay. Ask if the clinic accepts Medicare's price as full payment, because then you pay 20% of that price.
5. Read your Medicare Summary Notice, which Medicare mails every 6 months if you had care. If a visit was denied, call the clinic first.

If you have a Medicare Advantage plan

Your plan must cover the therapy Original Medicare covers. It may need to approve it first, send you to a therapist in its network, or charge a copay for each visit. Call your plan before your first visit.

What a Pair Team advocate does

Therapy often comes after a fall, a new knee or a hospital stay. People call us when getting there is the hard part, or when the clinic says Medicare won't pay anymore. This is what we do:

• Find a therapist near you who takes Medicare, or one who comes to you.
• Set up rides to therapy and back.
• Ask for the reason in writing if therapy is cut, and help you appeal.
• Help with what comes with it: a walker or shower chair, home health and help at home.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Do I need a referral to see a physical therapist?

For Medicare to pay, a doctor, nurse practitioner or physician assistant must sign your therapy plan. The therapist can write the plan and send it to your doctor to sign.

Can I do physical therapy by video?

Yes, you can do physical therapy by video if your therapist offers it. Congress extended the rules that let physical therapists see Medicare patients by video through December 31, 2027.

Does Medigap pay the 20%?

Medigap plans pay all or part of your share, and so does the Qualified Medicare Beneficiary (QMB) program, one of the Medicare Savings Programs.

Does Medicare cover occupational and speech therapy?

Yes, Medicare covers occupational and speech therapy with the same 20% and no yearly cap. Speech therapy counts toward the same $2,480 as physical therapy, and occupational therapy has its own.

Does the $2,480 start over each year?

Yes, the threshold starts over each year and counts from January 1. Passing it late in one year has no effect on the next.

Sources

• Physical therapy services, Medicare.gov
• Therapy Services, CMS
• Jimmo Settlement, CMS
• Requirements for medical and other health services furnished by providers under Medicare Part B (42 CFR 424.24), Legal Information Institute
• Outpatient Therapy Services and ABN Use, Noridian Medicare
• Home health services, Medicare.gov
• Medicare Summary Notice (MSN), Medicare.gov
• Skilled nursing facility care, Medicare.gov
• SNF Consolidated Billing, CMS
• Compare Original Medicare and Medicare Advantage, Medicare.gov
• 2026 Medicare Parts A and B Premiums and Deductibles, CMS
• Is Mobile Outpatient Therapy an Alternative to Home Health Care?, Center for Medicare Advocacy