| Tue, Jun 25, 2019 @ 07:41 AM

What Does Medicare Cover for Outpatient Rehabilitation Therapy?

Posted by Medicare Made Clear

Medicare covers three main types of outpatient rehabilitation therapy:

  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services

Medicare Part B pays 80 percent of the Medicare-approved amount for outpatient therapy services received from a provider who accepts Medicare assignment. You are responsible for 20 percent of the cost after meeting the Part B deductible. Some Medicare supplement plans may help pay your out-of-pocket costs for outpatient therapy.

Your costs for Medicare rehab coverage with a Medicare Advantage plan (Part C) depend on the specific plan you have. Medicare Advantage plans are offered by private insurance companies and approved by Medicare. These plans must provide coverage at least as good as what’s provided by Original Medicare (Parts A & B).

Is There a Limit on Medicare Coverage for Outpatient Therapy?

While there is no limit on what Medicare will pay for outpatient therapy, your provider must confirm that your therapy is medically necessary once he cost reaches a certain amount. The amount is set by Medicare each year. In 2019, the amount is $2040.

Your provider must notify you before providing care that is not medically necessary so you can decide whether or not you want the services. The notice is called an Advance Beneficiary Notice of Noncoverage (ABN). If your provider gives you an ABN, you may agree to pay for the services that aren’t medically necessary. However, Medicare will not help cover the cost.

What is the Medicare Therapy Cap?

The Medicare therapy cap was a set limit on how much Original Medicare would pay for outpatient therapy in a year. Once that limit was reached, you had to request additional coverage through an exception in order to continue getting covered services. However, by law, the therapy cap was removed entirely in 2019.

Where Can You Get Outpatient Therapy Services?

Medicare covers outpatient therapy services that you get from physical therapists, occupational therapists, speech-language pathologists, doctors and other health care professionals. The services may be provided in the following locations:

  • A therapist’s or doctor’s office
  • A rehabilitation agency
  • A comprehensive outpatient rehabilitation facility
  • A skilled nursing facility when you’re there as an outpatient
  • Your home, from certain therapy providers, when you’re not eligible for Medicare’s home health benefit

For more information about Medicare, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.