Yes. Medicare Part B covers outpatient physical therapy when it is medically necessary and your doctor or another allowed provider certifies that you need it. After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount, and Medicare sets no fixed number of sessions or yearly dollar limit as long as the therapy stays medically necessary.
The same Part B rules cover occupational therapy (help with dressing, bathing and other daily activities) and speech-language pathology (speech, language, cognitive and swallowing skills). Below: what you pay, the 2026 threshold, the “improvement” myth, home and Medicare Advantage rules, New York Medicaid and how to start.
What does Medicare cover for physical therapy, and where?
According to Medicare.gov, therapy can help restore movement after an injury, illness or surgery, and it can also help you improve or maintain your current function or slow your rate of decline. The rules and your cost depend on where you get it.
| Where you get therapy | Which Medicare benefit | What you pay | Main condition |
|---|---|---|---|
| A clinic, hospital outpatient department or therapist’s office | Part B outpatient therapy | Part B deductible, then 20% of the Medicare-approved amount | Medically necessary, provider certifies the plan of care |
| Your home, through a home health agency | Home health benefit (Parts A and B) | $0 for covered home health services | Homebound, part-time skilled care, ordered by a provider |
| A skilled nursing facility after a hospital stay | Part A skilled nursing facility care | Depends on the day of the stay | Qualifying inpatient hospital stay first |
| Any setting, if you have a Medicare Advantage plan | Your plan, which must cover what Original Medicare covers | Set by your plan | Network and prior authorization rules may apply |
Sources: the Medicare.gov pages on physical therapy, home health and skilled nursing facility care.
How much do you pay for Medicare physical therapy in 2026?
For outpatient therapy you pay the yearly Part B deductible, which Medicare.gov lists at $283 for 2026, and then 20% of the Medicare-approved amount for each visit. Your bill also depends on whether the provider accepts assignment and the type of facility. Our guide to Part B costs covers the premium.
That 20% has no ceiling in Original Medicare, so many people have help paying it:
- Medigap. A Medicare Supplement policy can cover the Part B coinsurance. See Medigap in New York.
- Medicare Savings Programs. Medicare.gov says the Qualified Medicare Beneficiary (QMB) program helps pay Part B deductibles, coinsurance and copayments for Medicare-covered services.
How many physical therapy sessions does Medicare cover?
Medicare does not set a number. Medicare.gov states there is no limit on how much Medicare pays for medically necessary outpatient therapy services in one calendar year. What controls the number of visits is the plan of care, which the Medicare Benefit Policy Manual, chapter 15, describes this way:
| Step | What the manual says |
|---|---|
| Plan of care | Written before treatment, by the therapist or a doctor or other allowed provider, with goals and the expected amount, frequency and duration of care |
| Certification | A doctor or other allowed provider signs the plan, ideally within 30 days of the first treatment |
| Length of one certification | Up to 90 calendar days; longer treatment needs a recertification |
| Progress reports | The therapist writes one at least every 10 treatment days |
| Reasonableness | The amount, frequency and duration must be reasonable under accepted standards of practice |
So a longer recovery can run many weeks and a minor problem only a few. The therapist’s records, not a Medicare quota, have to justify each visit. Medicare.gov also warns that a provider may suggest services Medicare does not cover or covers less often, so ask what you would owe.
What are the 2026 therapy threshold and the KX modifier?
Medicare no longer has a hard cap. Congress repealed the outpatient therapy caps in 2018 but kept the old amounts as thresholds. On its Therapy Services page, CMS gives the 2026 KX modifier threshold as $2,480 for physical therapy and speech-language pathology combined and a separate $2,480 for occupational therapy.
Above that amount the provider must add a KX modifier to the claim, which confirms the services are medically necessary and supported by the medical record. CMS says claims over the threshold without it are denied. A second, higher threshold of $3,000 can trigger targeted medical review of the records. Under the manual, if a claim is denied for a missing KX modifier, the provider is responsible for the cost unless the patient was given a valid Advance Beneficiary Notice (ABN) beforehand.
Crossing the threshold does not by itself end therapy. It means the clinic must document why more is needed. If you are handed an ABN, ask what it covers and call 1-800-MEDICARE or HIICAP before signing.
Does Medicare only cover therapy if you are improving?
No. This is a common myth. In the Jimmo settlement (approved by a federal court in January 2013), CMS clarified that coverage of skilled nursing and therapy in skilled nursing facilities, home health and outpatient therapy does not turn on whether you can improve, but on whether you need skilled care. Skilled care can be covered to maintain function or to prevent or slow decline, provided the other coverage rules are met.
The manual draws the line carefully for maintenance therapy:
- Covered: a therapist designing a maintenance program, teaching you or a caregiver to carry it out, and rechecking it periodically, when that takes a therapist’s skills.
- Covered: ongoing therapist-delivered care when only a therapist can do it safely and effectively.
- Not covered: a maintenance routine that you, a family member or an aide can carry out alone, and general exercise for overall fitness.
Our stroke recovery guide and post-surgery care page describe typical recovery needs at home.
Is physical therapy at home covered by Medicare?
It can be, in two different ways.
- Through home health. If you are homebound and a provider orders it, therapy can be part of home health care from a Medicare-certified agency, and Medicare.gov says you pay nothing for covered home health services. Details are in our guide to the Medicare home health benefit.
- Through Part B. The manual says outpatient therapy is payable when a provider or a therapist in private practice furnishes it in the patient’s home, at the same fee schedule rates as other outpatient settings, with additional travel costs not covered. The deductible and 20% apply. Ask whether the therapist is enrolled in Medicare and charges for travel.
After a hospital stay, care may also start in a facility. If you stay in a skilled nursing facility, Part A covers therapy as part of that stay when you meet its rules, including a qualifying inpatient hospital stay. See our guide to skilled nursing facility coverage and days and the hospital discharge checklist.
What if you have Medicare Advantage?
A Medicare Advantage plan must cover the services Original Medicare covers. Federal rule 42 CFR 422.101 requires plans to follow Medicare’s coverage criteria and says they may not deny basic benefits on criteria that are not in those rules. But Medicare.gov notes that in most cases Original Medicare does not require prior authorization, while with a Medicare Advantage plan you may need approval before it covers certain services.
- Call the number on your plan card. Ask whether outpatient therapy needs prior authorization, whether the therapist is in your network and what your copay is per visit.
- If a request is denied, ask the plan for the written reason and the appeal steps, and call HIICAP.
Plans differ in their visit costs, networks and authorization steps, so no single number applies to everyone. Our Medicare Advantage versus Original Medicare guide compares the two.
What does New York Medicaid cover for physical therapy?
New York Medicaid covers therapy too, and it matters most if Medicare does not apply to you or you have both. The eMedNY Rehabilitation Services schedule (January 2026) says medically necessary occupational therapy, physical therapy and speech therapy visits are covered in private practitioners’ offices, certified hospital outpatient departments and diagnostic and treatment centers, ordered in writing by a physician, physician assistant or nurse practitioner.
| Medicare Part B | New York Medicaid (eMedNY) | |
|---|---|---|
| Who starts it | Therapist’s plan of care certified by a doctor or other allowed provider | Written order from a physician, physician assistant or nurse practitioner |
| Who provides it | A qualified therapist, or an assistant under supervision | A licensed, qualified practitioner; aides and trainers do not qualify |
| Cost to you | Deductible, then 20% | Set by Medicaid rules and your plan; ask the provider |
| Maintenance | Covered when a therapist’s skills are needed | “Long term therapy services” to prevent deterioration are defined in the policy guidelines |
| Visit limit stated | None; threshold and documentation rules apply | None stated in the January 2026 schedule |
Sources: the eMedNY Rehabilitation Services Policy Guidelines and the Medicare manual above. The policy guidelines require an evaluation, a treatment plan with measurable goals and skilled care that a home program could not replace. Older eMedNY versions listed visit limits and prior authorization, so confirm with the therapist and, for a Medicaid managed care plan, with the plan itself. See also Medicare versus Medicaid.
How do you find a physical therapist and what should you ask?
- Ask your doctor for an order or referral. Medicare requires you to be under a provider’s care and the plan to be certified, so tell your doctor you want therapy.
- Search for providers that take Medicare. Medicare.gov has a provider search on its physical therapy page. Use your plan’s directory if you have Medicare Advantage.
- Check the license. The New York State Education Department offers an online license verification search.
- Call the office with these questions: Do you accept Medicare assignment? Do you bill my plan, and does it need prior authorization? What will I owe per visit? How many visits do you expect, and what are the goals? Do you make home visits? What happens if I reach the therapy threshold?
What happens at the first physical therapy visit?
The first visit is mainly an evaluation. The Medicare manual and the New York Medicaid guidelines describe what the therapist should record: your prior level of function, test results and baseline findings, a plan with specific techniques, how often and how long you will be treated, measurable goals, the expected outcome and a discharge plan.
Bring your insurance cards, medication list and any discharge papers, and say plainly what is hard: stairs, getting out of a chair, walking to the corner. The therapist sends the plan to your doctor for certification.
Which exercises can you do at home between visits?
Your therapist decides what is safe for you, and the exercises they give you are the ones to follow. For general background only, the National Institute on Aging says older adults benefit from a mix of aerobic, muscle-strengthening and balance activity. Its tips include:
- Build up gradually to at least 150 minutes a week of moderate activity such as brisk walking, if your doctor agrees.
- Do balance exercises about three times a week, with a sturdy chair, person or wall nearby for support.
- Listen to your body, and stop if you feel dizziness, chest pain or pressure, or nausea.
- If you are unsure about a movement, ask your doctor or physical therapist.
Our fall prevention guide for NYC apartments covers the home side of fall risk.
Help with therapy at home from ProLife
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. Our therapy at home page describes physical, occupational and speech therapy visits with a doctor’s order, paid privately or under contract with a certified home health agency. We do not bill Medicare for therapy ourselves, and we say so on the first call. Call (718) 232-2777 or use our contact page.
Medicare and Medicaid rules, dollar amounts and plan policies change each year. Everything above was checked on 15 October 2026 against medicare.gov, cms.gov, ecfr.gov, emedny.org, nia.nih.gov and shiphelp.org. Confirm your own situation with your provider, your plan, HIICAP (1-800-701-0501) or 1-800-MEDICARE. This page is general information, not medical or legal advice.
Frequently asked questions
Does Medicare cover physical therapy?
Yes. Part B covers medically necessary outpatient physical therapy when a doctor or other allowed provider certifies the need. After the Part B deductible you pay 20% of the Medicare-approved amount.
How many physical therapy sessions does Medicare cover?
There is no fixed number. Medicare.gov says there is no limit on how much Medicare pays for medically necessary outpatient therapy in a calendar year, so the plan of care and the therapist’s records decide how many visits are justified.
Does Medicare have a therapy cap in 2026?
No hard cap, but there is a threshold. CMS lists $2,480 for physical therapy and speech-language pathology combined and $2,480 for occupational therapy in 2026. Above it, the provider must add the KX modifier with supporting documentation.
Do you need a doctor’s referral for Medicare physical therapy?
Medicare requires a doctor or other allowed provider, such as a nurse practitioner, clinical nurse specialist or physician assistant, to certify that you need therapy. Ask your provider for the order before the first visit.
Will Medicare stop paying if I am not improving?
Not for that reason alone. Under the Jimmo settlement, CMS says coverage depends on the need for skilled care, not on whether you can improve. Therapy to maintain function or slow decline can be covered when a therapist’s skills are needed.
Does Medicare pay for physical therapy at home?
It can, if you are homebound and get it through a Medicare-certified home health agency, where covered services cost you $0. A therapist can also see you at home under Part B, with the deductible and 20% applying.
Does Medicare Advantage cover physical therapy?
Yes, a plan must cover what Original Medicare covers, but it may require prior authorization, a network provider and its own copay. Ask your plan before starting treatment.
