Part B Medicare Coverage: Your Guide to Receiving Outpatient Physical Therapy at Home

Frailty is a condition many older adults experience as they age. It’s a condition defined by lower physicality, increased hospitalization, and even death. 

Luckily, non-surgical treatments like physical therapy can help reduce frailty and improve independence. Even better, Medicare members can get coverage for outpatient physical therapy treatments. 

Are you looking for a Medicare-covered solution to your mobility problems? Then you need to keep reading because this article is for you!

What is Physical Therapy?

Physical therapy is a non-invasive treatment. It’s designed to help people restore, develop, or improve body movements. It harnesses a variety of treatment techniques, from ice-heat therapy to manual massage.

Medicare members often seek physical therapy after a fall. If that sounds like you, keep reading to learn more about physical therapy and how Medicare can help pay for it. 

The Benefits of Physical Therapy

Research shows that physical therapy is effective, inexpensive, and safe for patients. 

A licensed physical therapist can help aging individuals improve strength, balance, and coordination. Even better, physical therapy is beneficial for reducing pain and increasing flexibility.  

One study looked at the rates of success for surgical and physical therapy. They studied older adults suffering from a condition called Spinal Stenosis. The researchers found that physical therapy treatments were as effective as surgery. 

Physical therapy also helps to cut costs. Studies have looked at the difference in costs for seniors with mobility problems. These studies show that frailty costs older adults between 22% and 46% more in health care costs.

Yet, treatment costs fall 50%when physicians refer patients to a physical therapist. This is especially true when patients see physical therapists before imaging specialists. Patients can save up to 72% in the first year of treatment by seeing a physical therapist.

Physical therapy is also proven to be as safe as it is effective. A 2013 study looked at the safety of physical therapy for vulnerable populations. It found that physical therapy was even safe for patients with critical illnesses.

Inpatient vs. Outpatient Physical Therapy

Physical therapists work in inpatient and outpatient settings. Inpatient physical therapy is therapy you get from a PT who works in a hospital. Outpatient physical therapy takes place in a clinic or at a rehab center.

Outpatient physical therapy may also take place at a skilled nursing facility. But that’s only if the patient’s stay isn’t eligible for Medicare coverage. Patients ineligible for home health benefits can receive coverage for at-home physical therapy.

Medicare coverage depends on whether you see an inpatient or outpatient physical therapist. 

Who Needs Physical Therapy?

Physical therapy is for people of all ages and in different stages of life. Back pain is one of the most common reasons for physical therapy. Other conditions that may need physical therapy treatments include:

For example, a child might receive physical therapy for a developmental disorder. A young person might receive physical therapy after a sports injury. 

Medicare members may receive physical therapy for many reasons. Common ones include reducing fall risks, maintaining mobility, and improving coordination. 

Does Medicare Cover Physical Therapy?

Medicare does cover physical therapy for members.

Original Medicare Part A covers inpatient rehabilitation care, including physical therapy. Outpatient physical therapy patients can get coverage under Original Medicare Part B. 

Seniors can also receive physical therapy coverage under Medicare Advantage plans. These are private Medicare plans.

Adults aged 65+ can sign up for Medicare Advantage with private insurance companies. By law, these private plans must offer the same coverage Original Medicare offers. 

Medicare Part B Outpatient Physical Therapy Coverage

Original Medicare Part B covers medically necessary physical therapy. Medicare patients must first meet the Part B deductible, which is $198 in 2020. Once patients hit their deductible, Medicare covers 80% of in-network physical therapy costs. 

Extra requirements for physical therapy coverage include:

Before 2018, there was a cap on how long Original Medicare would cover physical therapy. Medicare replaced this cap with a coverage cost threshold. 

In 2020, Original Medicare covers physical therapy up to $2,080. What happens when a patient meets the threshold? Their physician must deem the treatments medically necessary to continue getting Medicare coverage.

What Does It Mean to Be Medically Necessary?

What happens when you hit the cost threshold for Medicare-covered physical therapy? Your doctor has to agree your treatments have some medical necessity. That way, you can continue receiving benefits.

But what exactly does that mean?

The Centers for Medicare and Medicaid Services defines “medically necessary” services as::

A doctor will deem the physical therapy necessary for your condition. Then, he or she will give you a Certificate of Medical Necessity. This important document proves that you’re eligible for continuing outpatient physical therapy coverage.

Get Medicare-Covered Outpatient Physical Therapy 

Outpatient physical therapy can help elderly adults. Treatments assist with fall recovery, mobility improvement, and more.

Medicare Part B will cover physical therapy treatments in outpatient settings. Medicare will only cover treatment up to a cost threshold, though. Then, your physician must deem your treatment has some medical necessity.

Are you searching for an outpatient facility to receive Medicare-covered physical therapy? Therahealth & Wellness is the place to be. Contact us today to set up your first appointment!