“Physiotherapists are movement experts,” says Roger Herr. American Physical Therapy Association (APTA) President. They are especially important for older people, given that half of physiotherapists’ patients over 65 years of age, and this number is expected to rise as the population ages.
“As part of their practice, physical therapists provide assessment, consultation, education and treatment to improve balance, mobility, strength and endurance, coordination and flexibility,” says Herr.
Common conditions treated with physical therapy include osteoarthritis, low back pain, and urinary incontinence.
“Physical therapy can also be useful as a preventative measure, such as when you feel shaky legs, to prevent a fall, or it can help you recover from a fall or surgery,” Herr says.
Medicare coverage of physical therapy services
Whether you are in an institution such as a hospital or nursing home, or at home and need physical therapy, Medicare provides coverage to treat a chronic condition such as multiple sclerosis (MS), treat an injury or illness, or to maintain your independence. Although an order or referral is not required under Medicare, a doctor, nurse practitioner, clinical nurse practitioner, or physician assistant must certify that the services are medically necessary.
Medicare Part A will fully cover inpatient physical therapy For the first 60 days after payment of the deductibleprovided that skilled nursing and/or rehabilitation services are needed on a daily basis. After this, surcharges apply.
Ambulatory treatment, which includes physical therapy clinic or home visits for seniors who are homebound, is covered by Medicare Part B. After you meet your annual deductible, Medicare pays 80% and you pay 20% of the Medicare-approved amount. .
If you haven’t checked your coverage recently, you may be eligible for additional benefits.
“Medicare coverage of physical therapy changed in 2018,” says Diane Omdahl, author of Medicare for you and co-founder of the Medicare consulting firm 65 Incorporated.
“Before this, there were restrictions on coverage. The rule has changed to unlimited Medicare coverage for medically necessary outpatient physical therapy services each calendar year,” says Omdahl.
Medicare Advantage coverage for physical therapy services
“Medicare Advantage plans may require prior authorization before approving your physical therapy treatment,” Herr says. “Your physical therapist may have to conduct an assessment and submit a treatment plan in order to be approved for insurance coverage,” Herr explains.
Once approved, Medicare Advantage plans offer the same coverage as Medicare Parts A and B, with some exceptions. Medicare Advantage plans may have different deductibles, require members to use physical therapy services from their network and/or conduct more frequent audits or reviews to minimize costs and reduce overutilization, Herr says.
Medicaid coverage of physical therapy services
Physical therapy coverage under Medicaid is additional benefit depending on your stateso you will need to check that benefits your state offers.
Coverage of occupational therapy and speech pathology
“In addition to physical therapy, Medicare, Medicare Advantage and Medicaid generally provide the same coverage for other rehabilitation modalities if they are deemed medically necessary,” Herr says.
This includes occupational therapyor assistance to help you perform activities of daily living (such as bathing or dressing), housekeeping, and returning to the community to maintain current abilities or slowly decline.
It also includes speech pathologywhich offers assistance with speech, language, swallowing, and cognitive skills to maintain or improve current function or slow decline.
Outpatient physical therapy in a facility or at home – which is better?
All outpatient treatment is covered by Medicare Part B, but you may wonder if physical therapy at home is as beneficial as in a facility.
“Physical therapy locations may have additional equipment and resources than what a physical therapist can provide at home,” says Herr.
In addition, wait times for physical therapy services at a facility may be shorter than at home, Guerra said.
“Going to physical therapy also helps with socialization, which could be difficult when dealing with mobility issues,” says Herr.
However, for some patients, home-based outpatient therapy provides an opportunity to address environmental issues at home and ensure that the person can manage the situation safely and independently in their own environment. Home-based therapy also improves access to therapy for those who lack reliable transportation, Guerra said.
Physical therapists are hard to find.
Although Medicare covers physical therapy, it can be difficult to find a physical therapist.
“The shortage of physical therapists has peaked during the pandemic, but we are still seeing vacancies in the double digits,” Herr says.
Other factors continue to contribute to the ongoing shortage, according to a KFF news report. First, physical therapists are now required to have a doctorate, so fewer students are entering the field. Another reason is that Medicare has cut reimbursement for physical therapy by 9% over the past four years, leading to a reduction in staffing.