Does Medicare Cover Physical Therapy?
By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published November 2026
Your knee has been aching on the stairs, your balance hasn't felt right since a fall, or your surgeon says you'll need rehab after a hip replacement. You're on Medicare and wondering what it will cover, how much you'll pay, and whether there's a limit on visits.
Medicare coverage for physical therapy is better than many people expect, but the rules can be confusing. This article explains what Original Medicare Part B covers, what you typically pay, whether there's a cap on visits, how Medicare Advantage plans differ, and how to get started at Nova Physical Therapy in North Hollywood.
The short answer
Yes. Medicare Part B covers outpatient physical therapy when it's medically necessary. After you meet the yearly Part B deductible, you typically pay 20% of the Medicare-approved amount (Medicare.gov). There's no hard cap on visits. For 2026, once therapy costs pass $2,480 for physical therapy and speech therapy combined, your therapist confirms that continued care is medically necessary for Medicare to keep paying (CMS). Medicare Advantage plans have their own rules, so check with your plan. Nova Physical Therapy in North Hollywood works with Medicare patients.
What does Medicare cover for physical therapy?
Original Medicare Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology when they are medically necessary (Medicare.gov). That commonly includes care for:
- Back, neck, knee, hip, and shoulder pain
- Balance problems and fall prevention
- Recovery after joint replacement and other surgery
- Arthritis and loss of strength or mobility
- Recovery after an injury or hospital stay
Coverage doesn't depend on whether you'll improve. Under the Jimmo settlement, skilled therapy can be covered when it's needed to maintain your function or slow decline, not only to improve it (CMS Jimmo fact sheet).
How much will I pay?
With Original Medicare (Medicare.gov):
- You first pay the yearly Part B deductible.
- After that, you typically pay 20% of the Medicare-approved amount for each visit.
- Medicare pays the rest for covered, medically necessary care.
If you have a Medicare Supplement (Medigap) plan or other secondary coverage, it may help pay some or all of your 20%. Your exact cost depends on your coverage, so our front desk can help you check before your first visit.
Is there a limit on physical therapy visits?
No hard cap. Medicare's old therapy caps were repealed (CMS). Instead:
- Yearly threshold: for 2026, once therapy costs pass $2,480 for physical therapy and speech therapy combined, your therapist adds a code confirming the care is still medically necessary (CMS).
- Review threshold: above $3,000, some claims may be selected for medical review, though not every claim is reviewed (CMS).
- Notice before non-covered care: if a service isn't medically necessary, your provider must give you a written notice (an ABN) before you receive it, so you can decide. A provider can't give you that notice just because you've reached a certain dollar amount (Medicare.gov).
Do I need a doctor's referral for Medicare physical therapy?
Medicare generally doesn't require a prescription to start physical therapy, but it does require your plan of care to be signed, or certified, by a physician or a qualified provider such as a nurse practitioner or physician assistant. Certification is due within 30 days of your first visit, and is renewed at least every 90 days while you're in care (WebPT summary of Medicare rules).
In practice, that means you can call us to get started, and our team coordinates the plan of care with your doctor.
What about Medicare Advantage plans?
Medicare Advantage (Part C) plans must cover what Original Medicare covers, but they set their own rules. Many have:
- A set copay per visit instead of 20%
- Referral or prior authorization requirements
- A network of contracted clinics
Medicare advises checking with your plan for coverage details (Medicare.gov). Our team can help you check your benefits before you start.
How can physical therapy help?
Many Medicare patients come to physical therapy to stay strong, steady, and independent. A physical therapy evaluation may include:
- Your health history, goals, and what's been hard to do
- Strength, flexibility, and joint motion
- Walking, balance, and fall risk
- Getting up from a chair, stairs, and daily tasks
- Screening for signs that need a physician's evaluation
A typical plan may include:
- Strength and balance training
- Walking and fall prevention strategies
- Hands-on treatment for stiff or painful joints
- Rehab after surgery, following your surgeon's protocol
- A home program you can keep doing on your own
Physical therapy doesn't guarantee a specific result. At Nova Physical Therapy in North Hollywood, we treat back and neck pain, joint pain, balance problems, and recovery after surgery, and every plan starts with an evaluation so treatment fits what we find. Learn more on our insurance page.
When should I see a doctor first?
Get emergency care for chest pain, sudden weakness or numbness on one side of the body, trouble speaking, a fall with a possible broken bone or head injury, or loss of bladder or bowel control.
See a physician promptly for new pain after a fall, unexplained weight loss or fever, or pain at night that doesn't ease with changing position.
We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.
Frequently asked questions
Does Medicare cover physical therapy?
Yes. Medicare Part B covers outpatient physical therapy when it's medically necessary. You typically pay 20% of the Medicare-approved amount after your yearly deductible.
How many physical therapy visits does Medicare allow?
There's no set number of visits. Above a yearly dollar threshold, your therapist confirms that continued care is medically necessary.
Does Medicare cover physical therapy at home?
Medicare can cover therapy at home under the home health benefit if you qualify. This article is about outpatient therapy at a clinic.
Will Medicare stop paying if I'm not improving?
Not necessarily. Skilled therapy needed to maintain function or slow decline can be covered, not only care that leads to improvement.
Does Medicare cover physical therapy after knee or hip replacement?
Outpatient therapy after joint replacement is commonly covered when it's medically necessary, following your surgeon's plan.
Do Medicare Advantage plans cover physical therapy?
Yes, but each plan has its own copays, networks, and referral or authorization rules. Check with your plan or ask our team to help.
Do I need a referral to see a physical therapist?
Not to start in California, within the limits described above. Medicare does require a physician or qualified provider to certify your plan of care, and we coordinate that.
About Nova Physical Therapy
Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from back and neck pain, sports injuries, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.
Schedule an evaluation
If you’re on Medicare and want help with pain, balance, or recovery after surgery, call us and we’ll help you check your coverage and get started.
Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online
Disclaimer
This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Coverage rules change and depend on your specific plan; confirm your benefits with Medicare or your plan. This article is not insurance or legal advice. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.
References
- Medicare.gov. Physical therapy services. Link
- Centers for Medicare & Medicaid Services. Medicare Coverage of Therapy Services (publication 10988). Link
- Centers for Medicare & Medicaid Services. Therapy Services: CY 2026 updates. Link
- Centers for Medicare & Medicaid Services. Jimmo v. Sebelius Settlement Agreement fact sheet. Link
- WebPT. Medicare and Direct Access. Link