Coverage, decoded

Physical therapy on Medicare: no cap, no limit, one condition

Short answer: yes. Medicare Part B covers outpatient physical therapy (and occupational and speech therapy) with no annual dollar cap and no visit limit, as long as it’s medically necessary and your provider documents it. You pay 20% after the $283 deductible, which Medigap absorbs. The old "therapy cap" people remember was repealed in 2018; what replaced it is a documentation checkpoint, not a ceiling.

By the Medicare Decoder team · Updated August 10, 2026 · 4-minute read · Figures are official 2026 amounts

Key takeaways

Part B covers medically necessary outpatient PT, OT, and speech therapy with no annual visit or dollar limit.
Your cost: 20% after the $283 deductible; Medigap plans pay the 20%, Advantage plans charge per-visit copays instead.
The old hard "therapy cap" was permanently repealed in 2018; above a dollar threshold, providers simply document continued necessity.
Maintenance therapy counts: care to keep your condition from worsening qualifies, not just care that improves you.
No doctor’s referral is federally required to start (direct access varies by state practice rules), but a certified plan of care is.

Jump to What’s covered What it costs The cap that died “Medically necessary,” used well Settings and plans FAQ

What’s covered

Part B covers outpatient physical therapy (movement, strength, balance, pain), occupational therapy (daily-living function), and speech-language pathology, delivered in clinics, hospital outpatient departments, or at home when you don’t qualify for the home health benefit. The medical trigger list is broad: post-surgical rehab (knees, hips, shoulders), stroke recovery, balance and fall prevention, arthritis management, back pain, Parkinson’s programs, vestibular therapy. A therapist evaluates you, writes a plan of care, and a physician or qualified practitioner certifies it; that certified plan is the coverage engine.

What it costs, by configuration

Medicare-approved amounts for therapy visits are modest (regionally variable), so the 20% coinsurance typically lands in the $15–$35-per-visit range on Original Medicare alone. With Medigap, the 20% is paid: a 40-visit rehab year costs you nothing beyond the $283 deductible, which is precisely the "predictable" temperament the Medigap crowd is buying. On Advantage, expect a per-visit copay (commonly $10–$45) and, for longer courses, plan review of continued visits; a 40-visit year at a $30 copay is $1,200, which belongs in your plan-comparison math if therapy is a regular feature of your life.

The cap that died, and the checkpoint that replaced it

For years Medicare imposed annual dollar caps on therapy, and waiting rooms still repeat the folklore ("Medicare only covers 20 visits"). Congress permanently repealed the hard caps in 2018. What exists now is a threshold: above an annual dollar amount, your therapist adds a billing modifier attesting continued medical necessity, and at a higher amount, claims may face targeted review. Neither is a limit on you; both are paperwork on the provider. If someone tells you that you’ve "run out of Medicare therapy visits," the accurate translation is usually "our clinic doesn’t want to document further," and a second clinic may happily disagree.

Using "medically necessary" to your advantage

Maintenance qualifies. Under the Jimmo standard, therapy to maintain function or slow decline is covered; "you’ve plateaued" is not a legal endpoint. Appeals exist and succeed.
Function words matter. Coverage follows documented functional goals (walking distance, stair safety, fall risk), which is one reason to tell your therapist concretely what you can’t do, not just where it hurts.
Wellness isn’t covered. Once care becomes general fitness with no skilled component, coverage genuinely ends; many clinics offer reasonable cash "graduate" programs for exactly that phase.

Two boundary notes

Therapy inside a covered skilled nursing stay or home health episode is paid under those benefits, not this one; the rules in the home health article and the SNF section govern there. And chiropractic care is its own narrow lane (Medicare covers spinal manipulation only, not the X-rays or add-ons around it), so a back-pain plan built on covered PT usually travels farther than one built on partially covered adjustments.

Questions people also ask

How many physical therapy visits does Medicare cover?

There is no visit limit or annual dollar cap. Medicare covers outpatient PT as long as it’s medically necessary and documented; above a spending threshold, providers add a billing attestation, which is their paperwork, not your ceiling. The old hard therapy cap was repealed in 2018.

How much does physical therapy cost with Medicare?

On Original Medicare alone, 20% of the approved amount after the $283 deductible, typically $15–$35 per visit. With a Medigap plan the 20% is covered. Medicare Advantage plans charge per-visit copays, commonly $10–$45, which adds up across long rehab courses.

Do I need a doctor’s referral for physical therapy on Medicare?

You can generally start with a therapist evaluation directly (state practice rules vary), but Medicare requires a physician or qualified practitioner to certify the plan of care for coverage to continue. Practically, your therapist manages that certification.

Does Medicare cover physical therapy for chronic conditions or maintenance?

Yes. Under the Jimmo settlement standard, skilled therapy to maintain function or slow decline is covered, not just therapy that improves you. If coverage is ended because you’ve “plateaued,” that determination is appealable.

Does Medicare cover physical therapy at home?

Two ways: through the home health benefit at $0 if you’re homebound with a qualifying plan, or as regular outpatient Part B therapy delivered in the home when you’re not homebound, with normal 20% cost-sharing.

Sources for this article

Medicare.govIs my test, item, or service covered?: outpatient therapy coverage and cost-sharing.
Medicare.govMedicare.gov: therapy threshold and plan-of-care rules.
CMS.gov2026 premiums and deductibles: the $283 deductible and 20% structure.

Figures checked against these sources in August 2026. We update within weeks when CMS publishes new amounts.

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