Are you a senior wondering about Medicare physical therapy coverage? Fortunately, access to PT services is provided by Medicare if your primary care provider prescribes it as a medical necessity. The amount of therapy provided and copays required can vary based on several factors.
Physical Therapy Is A Form Of Healthcare
Physical therapy is a crucial type of healthcare that helps prevent or treat all kinds of medical conditions. The list of conditions that can be helped with PT is practically endless, but here are some examples that may be especially relevant to seniors.
- Surgical Recovery (Hip Replacement Etc.)
- Broken Bones
- Arthritis
- Headaches
- Vertigo
- Osteoporosis
- Parkinson’s Disease
- Respiratory Issues
- Cancer
What Does Medical Necessity Mean?
According to Medicare.gov, medical necessity means treatment must help treat an injury, disease, illness, or condition or its symptoms. The treatment also has to meet accepted medical standards.
So, for your PT to qualify under Medicare, your provider has to certify it as medically necessary. It doesn’t have to be a doctor; here’s a short list of qualified healthcare providers who can prescribe physical therapy.
- Physician
- Nurse Practitioner
- Clinical Nurse Specialist
- Physician Assistant
Medicare PT Services
When discussing physical therapy benefits under Medicare, we need to break them down into three types of services.
- Home Health Services
- Rehabilitation Services
- Outpatient Therapy
Now let’s take a look at these, one by one.
Home Health Services For Seniors
Here’s some good news for individuals who have been deemed medically homebound. Your medically-necessary PT is covered under Medicare. However, it must be a safe and effective specific treatment for your condition. The therapies must also be complex so that only a qualified therapist can perform them, and your condition should be one that can improve or be maintainable within a reasonable amount of time.
As for the cost, Medicare fully covers PT for homebound Medicare recipients. You must meet the part B deductible and pay 20% of the approved amount for covered medical equipment.
Medicare Rehabilitation Services For Inpatients
Medicare Part A also covers medically necessary care provided in an inpatient setting, such as an IRF (inpatient rehabilitation facility). You’ll have to pay a $1600 deductible for the first 60 days; after that, the copay amount goes up. It’s $400/day for days 61-90 and $800/day after that; eventually, you’ll be expected to cover the full cost yourself.
If you have some form of supplemental insurance plan, it may pick up some of the gaps.
Outpatient Therapy
Medicare Part B coverage includes PT services for people who need rehabilitation but don’t need a hospital stay. Your therapist may work for a private practice, hospital, or clinic. They are required to follow specific guidelines regarding the frequency and length of treatment.
First, you’ll have to meet your Part B deductible. After that, Medicare will pick up 80% of the cost, while you will be expected to pay 20%. An annual financial cap may apply.
We Accept Medicare!
Are you a Medicare recipient needing outpatient PT in Spokane Valley? Centennial Sports & Physical Therapy offers many clinic-based physical therapy services. Whether you’re recovering from surgery or a bad fall, need neck or back pain treatment, have a neurological condition, or require some other form of medically-necessary PT, our competent and compassionate therapists want to help.
Call today to schedule an appointment and get started on your recovery.
