Does Medicare Cover Physical Therapy? Costs, Limits and Referrals

Reviewed October 5, 2026. Yes, Medicare covers physical therapy when it’s medically necessary. Part B covers outpatient physical therapy with no yearly dollar cap, and you pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026). Part A covers physical therapy you get as a hospital inpatient, in a skilled nursing facility or through home health care.

Quick answer on referrals: Original Medicare doesn’t require a formal referral before you see a physical therapist, but your doctor, nurse practitioner, physician assistant or clinical nurse specialist must certify your therapy plan of care for Medicare to pay. Many Medicare Advantage HMOs do require a referral from your primary care provider, and some plans require prior authorization.

What physical therapy does Medicare cover?

Medicare.gov says Part B helps pay for medically necessary outpatient physical therapy, and that your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist or physician assistant) must certify that you need it (Medicare.gov). Therapy can be covered to:

• Restore movement and strength after an injury, illness or surgery, such as a hip or knee replacement
• Improve balance and walking after a fall or stroke
• Maintain your current function or slow a decline when you have a chronic or progressive condition

That last point matters. Under the 2013 Jimmo v. Sebelius settlement, CMS confirmed that coverage doesn’t depend on whether you’re expected to improve. Skilled therapy to maintain your condition or prevent it from getting worse can be covered when you need a therapist’s skills to provide it safely (CMS Jimmo settlement).

Which part of Medicare pays?

Sources: Medicare.gov physical therapy, Medicare.gov home health services and CMS 2026 Parts A and B premiums and deductibles. For home health rules, see Medicare’s homebound requirement.

Do you need a referral for physical therapy with Medicare?

With Original Medicare, it helps to separate two ideas:

• Seeing the therapist: Medicare itself doesn’t require a referral before your first physical therapy evaluation. Whether a therapist can evaluate and treat you without a doctor’s order also depends on your state’s practice laws.
• Getting Medicare to pay: the therapist must set up a written plan of care, and a physician or qualified non-physician practitioner must certify it. In practice, most therapists ask for an order from your doctor before or soon after your first visit.

With Medicare Advantage, rules vary by plan. HMOs commonly require a referral from your primary care provider and an in-network therapist. PPOs usually don’t require referrals, but out-of-network therapy costs more. Many plans also require prior authorization after a certain number of visits. See Medicare Advantage HMO vs. PPO.

Is there a limit on physical therapy visits?

There’s no limit on how much Medicare pays for medically necessary outpatient therapy in a year. Medicare.gov states this directly. However, Medicare uses a dollar threshold to check that therapy is still necessary:

• For 2026, the threshold is $2,480 for physical therapy and speech-language pathology combined, and a separate $2,480 for occupational therapy (CMS transmittal R13437CP).
• Once your therapy costs pass that amount, your therapist adds a code (the KX modifier) to confirm the services are medically necessary and documented.
• Therapy above the threshold is still covered when it’s medically necessary, but claims may be reviewed.

If your therapist thinks Medicare won’t pay for a service, they should give you an Advance Beneficiary Notice (ABN) before providing it.

How many physical therapy sessions does Medicare cover?

Medicare doesn’t set a fixed number of sessions. Coverage continues as long as your provider documents that skilled therapy is reasonable and necessary under your plan of care. Medicare Advantage plans must also cover medically necessary therapy, but many require prior authorization before or during a course of treatment.

How much does physical therapy cost with Medicare?

For outpatient therapy under Original Medicare, you pay the $283 Part B deductible once a year, then 20% of the Medicare-approved amount for each visit. The approved amount depends on the services billed, such as evaluation, therapeutic exercise or manual therapy. Medicare bills timed therapy codes in 15-minute units under the 8-minute rule.

Ways to lower your costs:

• Medigap: a Medicare Supplement plan can pay some or all of your 20% coinsurance. With Plan G, you’d typically pay only the Part B deductible. Compare what Medigap plans cover.
• Medicare Savings Programs and Medicaid: if your income is limited, a Medicare Savings Program may pay Part B cost-sharing.
• Choose a provider who accepts assignment, so you aren’t charged more than the Medicare-approved amount.

Physical therapy with Medicare Advantage

Medicare Advantage (Part C) plans must cover all medically necessary physical therapy that Original Medicare covers, but they set their own costs. Many charge a flat copay per outpatient therapy visit, and every plan has a yearly out-of-pocket maximum. When comparing 2027 plans during Open Enrollment (October 15 to December 7, 2026), look at:

• The copay for each outpatient rehabilitation visit
• Whether you need a referral or prior authorization, and after how many visits
• Which therapy clinics near you are in the network

Our Medicare plan comparison worksheet includes these items.

What isn’t covered

• Therapy that isn’t medically necessary, such as general fitness training
• Services your therapist can’t show require a skilled professional
• Gym memberships (some Medicare Advantage plans include fitness programs as an extra benefit)
• Massage therapy offered separately from a physical therapy plan of care

Frequently asked questions

Does Medicare cover physical therapy at home?

Yes. If you’re homebound and need skilled care, Medicare covers physical therapy through a Medicare-certified home health agency at no cost to you. If you aren’t homebound, Part B can still cover therapy a private-practice therapist provides in your home, with the usual 20% coinsurance.

How many physical therapy visits will Medicare pay for in a year?

There’s no set number. Medicare covers therapy as long as it’s medically necessary and documented. After your 2026 therapy costs pass $2,480, your therapist must confirm medical necessity on each claim.

Do I need a doctor’s prescription for physical therapy with Medicare?

Medicare requires a physician or qualified practitioner to certify your plan of care, so your therapist will need your doctor’s sign-off. State law decides whether you can be evaluated before that.

Does Medicare pay for physical therapy after knee replacement?

Yes. Medicare covers rehabilitation after a covered knee or hip replacement, whether you get therapy in the hospital, a skilled nursing facility, at home or as an outpatient.

Does Medicare cover physical therapy for chronic back pain?

Yes, when it’s medically necessary. Medicare also covers acupuncture for chronic low back pain under specific rules, and chiropractic spinal manipulation to correct a subluxation.

This article is general information, not medical or individual insurance advice. Medicare365 is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

Official sources

• Medicare.gov: Physical therapy
• Medicare.gov: Medicare coverage of therapy services (fact sheet)
• CMS: 2026 KX modifier threshold (transmittal R13437CP)
• CMS: Jimmo settlement
• CMS: 2026 Medicare Parts A and B premiums and deductibles