How Many Physical Therapy Visits Are Allowed on Medicare?
Physical therapy can be a crucial component of rehabilitation and recovery for individuals dealing with various health conditions. For many seniors and disabled individuals, Medicare plays a significant role in covering the costs of physical therapy. However, one common question that arises is how many physical therapy visits are allowed on Medicare. This article aims to provide an overview of the current guidelines and limitations regarding physical therapy coverage under Medicare.
Medicare, the federal health insurance program for people aged 65 and older, as well as certain younger individuals with disabilities, provides coverage for physical therapy services. The number of visits allowed under Medicare is determined by the patient’s specific needs and the approval of a Medicare-certified physical therapist.
Under the standard Medicare Part B coverage, which applies to outpatient physical therapy services, the number of allowed visits is subject to certain criteria. Initially, Medicare covers up to 80 days of physical therapy services per calendar year. However, the number of visits allowed beyond the initial 80 days depends on the patient’s progress and the approval of a Medicare review process.
The Medicare review process involves the assessment of the patient’s condition by a Medicare-certified physical therapist. If the therapist determines that the patient requires additional therapy beyond the initial 80 days, they can submit a request for continued coverage. This request must include documentation of the patient’s progress and the necessity for continued therapy.
If the request is approved, Medicare may cover additional therapy visits, but there is no set limit on the number of visits beyond the initial 80 days. The coverage will continue as long as the patient meets the necessary criteria and the therapist continues to document progress and necessity for therapy.
It is important to note that while Medicare covers physical therapy visits, there may be limitations on the amount that is covered per visit. Medicare has set a maximum amount that can be paid for each therapy session, known as the Medicare-covered amount. This amount is subject to change annually and is based on the current fee schedule.
Additionally, Medicare requires that the physical therapy services be provided by a Medicare-certified provider. This means that the therapist must be licensed in the state where they practice and must meet specific requirements to be eligible for Medicare certification.
In conclusion, the number of physical therapy visits allowed on Medicare is determined by the patient’s specific needs and the approval of a Medicare-certified physical therapist. While Medicare covers up to 80 days of therapy per calendar year, additional visits may be approved based on the patient’s progress and the therapist’s documentation. It is essential for patients to work closely with their therapists to ensure that they receive the necessary coverage and maximize their benefits under Medicare.
