Physical Therapy under Medicare

#Physical therapy/occupational therapy/speech-language pathology services

• Medicare Part B (Medical Insurance) helps pay for medically necessary, see clinical guidelines!,
  • outpatient physical  medicare.gov/physical-therapy
  • and Occupational therapy
• and.  Speech-language pathology services

• Your medical record must include information to explain why the services are medically necessary
• A Medicare contractor like Livanta  may review your medical records to be sure your therapy services were medically necessary. This happens when your bills go over say $2k  cms.gov/theraphy caps
• Your therapist or therapy provider must give you a written notice before providing services that aren’t medically necessary. This includes therapy services that are generally covered but aren’t medically reasonable and necessary for you at the time.
  • This notice is called an “Advance Beneficiary Notice of Noncoverage” (ABN). The ABN lets you choose whether or not you want the therapy services. If you choose to get the medically unnecessary services, you agree to pay for them.

Who’s eligible?

All people with Part B Out Patient are covered as long as the services are medically reasonable and necessary.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.   If you have a Medi Gap or Medicare Advantage plan, those will pay all or part of the 20%.

Resources & Links 

• • The Best Quadriceps Exercises to Build Stronger Thighs Very Well.com
  • Your Medicare Benefits Page 91
  • Medicare & Home Health Care
  • torrance memorial.org/transitional-care/
  • MLN Transitional Care Management Services pdf

• medicare.gov/transitional-care-management-services html
• 42 CFR § 410.60 – Outpatient physical therapy services: Conditions
• The complete Medicare guide for physical, occupational, and speech therapy.
• What does Medicare cover for outpatient rehabilitation therapy?   Medicare Made Clear
• CMS.gov Physical Therapy – Home Health
• medicare.gov/physical-therapy-services
• CMS.gov complex explanations
• Skilled Physical Therapy requirements §30.4.1
  • Guidelines §30.4.1.2
  • Inpatient 70.3