There is often confusion over how Medicare covers physical therapy. This affects one’s understanding of how their Medicare Supplement or Medicare Advantage plan will cover physical therapy for rehabilitation after injury or severe illness.
Medicare Part A covers rehabilitation services in a Skilled Nursing Facility after being in a hospital for at least three days. Medicare Part B covers outpatient physical, occupational, and speech therapy. Both coverages were designed with the goal of returning a patient to their state of health before the accident or illness.
The coverage limits for Medicare eligible rehabilitation services have been a topic of discussion in recent years. A 2013 class-action settlement determined that therapy services can continue after Medicare’s initial coverage limits as long as prolonged treatment is medically necessary.
The Part A skilled nursing coverage has a limit of 100 days. Part B physical therapy has a limit of $1,980. It’s important that you talk to your doctor and their medical staff to determine what is medically necessary for your treatment. Continued coverage after the Medicare limits also need to be submitted to Medicare or the insurer of a Medicare Advantage Plan with the correct billing code and documentation. Labor First’s team of Retiree Advocates are also always available to assist you with this process.