Medicare and physical therapy go hand in hand—especially when you’re recovering from surgery, managing chronic pain, or trying to stay mobile as you age. But here’s the problem: many people assume Medicare covers all physical therapy costs, only to be hit with surprise bills, limited sessions, or denied claims.
In 2025, understanding what Medicare covers for physical therapy can be the difference between getting the help you need and delaying recovery. Whether you’re considering outpatient rehab, in-home sessions, or therapy under a Medicare Advantage plan, this blog breaks down exactly what’s included—and what’s not.
Skyline Benefit, a top-rated Medicare insurance broker in California, is here to guide you through every step, so you can avoid costly mistakes and focus on healing.
What does Medicare cover for physical therapy in 2025?
Medicare covers physical therapy when it’s medically necessary and ordered by your doctor. This includes:
- Outpatient physical therapy under Medicare Part B
- Short-term inpatient rehab after a hospital stay under Part A
- In-home therapy for qualifying homebound individuals
- Physical therapy provided in skilled nursing facilities
If the service is deemed necessary and performed by a licensed therapist at a Medicare-approved facility, it will likely be covered, at least partially.
Medicare and physical therapy: How Part B works
When it comes to Medicare and physical therapy, most people receive their services on an outpatient basis, covered under Medicare Part B. In 2025:
- You’ll pay the $240 annual Part B deductible
- Medicare pays 80% of the cost after that
- You’re responsible for the remaining 20%
There’s no hard cap, but once therapy costs hit roughly $2,330, Medicare requires stronger documentation to keep covering your sessions.
Real-life example: What will Medicare pay for your therapy?
Let’s say you tore your rotator cuff and need rehab three times a week. Each visit costs about $100:
- Medicare pays $80
- You pay $20 (20% coinsurance) after the deductible
If you have a Medigap policy, it may cover the full 20%. If you’re on a Medicare Advantage plan, your copay could be lower, but you’ll need to stay in-network and may need prior authorization.
Common CPT codes for Medicare physical therapy billing
If you’re reviewing your Medicare Summary Notice or bills, you’ll often see the following CPT codes:
- 97110 – Therapeutic exercises (e.g., stretching, resistance)
- 97140 – Manual therapy techniques
- 97530 – Functional activities like balance or walking
- 97161–97163 – PT evaluations (based on complexity)
- G0283 – Electrical stimulation for pain
Understanding these codes helps ensure you’re being billed correctly and receiving covered services.
Does Medicare cover physical therapy at home?
Yes—if you’re homebound and qualify for Medicare home health care, you can receive in-home physical therapy.
Conditions include:
- A doctor certifies that you’re homebound and need therapy
- The therapy is expected to improve or maintain your condition
- A Medicare-certified home health agency provides services
This benefit is often underutilized, so ask your doctor if you qualify.
How do Medicare Advantage plans handle physical therapy?
Many Medicare Advantage (Part C) plans in 2025 enhance physical therapy coverage beyond Original Medicare. These plans may:
- Offer lower copays or waive deductibles
- Provide more therapy visits per year
- Include wellness programs or virtual rehab
- Require prior authorization before starting therapy
However, therapy must be received from in-network providers to avoid higher out-of-pocket costs.
How many therapy sessions will Medicare cover in 2025?
There’s no formal visit limit, but Medicare monitors usage closely. Once your costs exceed the annual therapy threshold (around $2,330 for 2025), your provider must prove medical necessity for each additional session.
This doesn’t mean you’ll be cut off, but Medicare won’t keep paying without documentation that you’re improving or stabilizing.
Who qualifies for Medicare-covered physical therapy?
You’re eligible if:
- You’re enrolled in Medicare Part B or a Medicare Advantage plan
- A doctor prescribes physical therapy as medically necessary
- A licensed therapist provides care in a Medicare-approved setting
Medicare and physical therapy benefits are available to anyone meeting those conditions, whether you’re recovering from a stroke, joint surgery, or managing chronic issues like arthritis or Parkinson’s disease.
Need help with Medicare and physical therapy in 2025?
Skyline Benefit is an independent health insurance broker in Fullerton, CA that offers affordable and flexible Medicare options. We will help you compare Original Medicare, Medicare Advantage, and Medigap options that best support your therapy and recovery goals.
Schedule a consultation today. Call us at: (714) 888-5112