Does Medicare Cover Physical Therapy at Home?

Dealing with a chronic condition or injury that affects mobility can be challenging. Physical therapy is a type of care that may be helpful when managing a disease or injury that changes your ability to function. It can be used to improve or maintain current function or even slow decline.¹ The demand for physical therapy is projected to come partially from baby boomers (born between 1946 and 1964²) that are more active later in life than previous generations. ³ Being older, these baby boomers are more likely to experience mobility-related injuries that need physical therapy for rehabilitation.³

Medicare can help with the cost of health care for people age 65 or older, or possibly earlier if you are on Medicare due to disability.⁴ If outpatient physical therapy is medically necessary, Medicare Part B (Medical Insurance) can help cover the cost when your doctor or other health care provider certifies you need it.¹

For those who require physical therapy services at home, Medicare considers physical therapy an eligible home health service if you have Medicare Part A (Hospital Insurance) and/or Medicare Part B and if the following conditions are met.  

1.  You must be under the care of a doctor and under a care plan that is established and regularly reviewed by a doctor. ⁵
2.  Your doctor must certify that you need physical therapy by a qualified therapist to maintain or improve your condition. ⁵
3. The home health agency providing your care is approved by Medicare (Medicare-certified). ⁵
4. You are homebound and a doctor certifies you as a homebound. ⁵

Before beginning physical therapy at home, you should speak with the home health agency that will be providing your care. The agency should be able to explain how much Medicare will pay, what isn’t covered by Medicare, and how much you will have to pay for any provided items or services that aren’t covered. Before providing you with any services and supplies that Medicare doesn’t cover, the home health agency should give you an Advance Beneficiary Notice of Noncoverage (ABN), which includes items or services that Medicare may not pay for, an estimated cost of those items and services, and the reasons why Medicare may not pay for them. ⁶

Physical therapy at home may be a convenient way to treat a covered injury or condition that affects mobility. If you are enrolled in Medicare and require physical therapy at home, it is helpful to know what is needed for Medicare to cover that service. For more information on Medicare and home health services you can visit medicare.gov.

Sources:

1. medicare.gov, Physical therapy, accessed March 2022
2. census.gov, By 2030, All Baby Boomers Will Be Age 65 or Older, 2019
3. bls.gov, Physical Therapists, 2021
4. medicare.gov, Get started with Medicare, accessed March 2022
5. medicare.gov, Home health services, accessed March 2022
6. medicare.gov, Your Protections, accessed April 2022