How Many Days of Physical Therapy Does Medicare Cover?
Physical therapy can be a crucial component of recovery for individuals suffering from various conditions, such as injuries, strokes, or chronic pain. For those who rely on Medicare, understanding how many days of physical therapy are covered is essential in planning their treatment and financial expectations. In this article, we will delve into the details of Medicare coverage for physical therapy, including the number of days covered, the criteria for eligibility, and the limitations that may apply.
Medicare Part B, which covers outpatient services, is responsible for covering physical therapy. The number of days of physical therapy that Medicare covers depends on several factors, including the individual’s medical necessity, progress, and the therapist’s recommendations. Generally, Medicare covers physical therapy services for up to 80 days per benefit period, provided that the individual meets specific criteria.
To qualify for Medicare-covered physical therapy, the individual must have a documented medical condition that requires skilled intervention. This means that the therapy must be provided by a licensed physical therapist and must be ordered by a physician. Additionally, the individual must have a face-to-face evaluation by a physician or qualified non-physician practitioner to determine the need for physical therapy services.
Once the individual meets the eligibility criteria, Medicare will cover the cost of physical therapy services for up to 80 days per benefit period. The benefit period is a 12-month period that begins the first day of any month in which the individual receives skilled nursing facility (SNF) care, home health care, or hospital care. If the individual has not used any of these services within the previous 12 months, the benefit period begins on the first day of the month in which they receive the services.
During the first 20 days of the benefit period, Medicare covers 80% of the approved charges for physical therapy, with the individual responsible for the remaining 20%. For days 21 through 80, Medicare covers 80% of the approved charges, and the individual is responsible for a $200 coinsurance payment per day.
It is important to note that Medicare coverage for physical therapy is subject to certain limitations. For example, the therapy must be deemed medically necessary, and the individual must progress to the point where they no longer require the skilled services of a physical therapist. In such cases, Medicare may stop covering the therapy, even if there are remaining days in the benefit period.
In conclusion, Medicare covers up to 80 days of physical therapy per benefit period, provided that the individual meets the eligibility criteria and demonstrates medical necessity. Understanding the intricacies of Medicare coverage for physical therapy can help individuals make informed decisions about their treatment and financial planning. It is always advisable to consult with a Medicare representative or a healthcare provider to ensure that all requirements are met and to understand any limitations that may apply.
