Physical therapy coverage under Medicare
What amount of physical therapy is actually covered by Medicare? Medicare Part B offers coverage for medically necessary physical therapy. In the recent past, there were caps on how much Medicare would cover for outpatient therapy services per year, however, in 2018 those caps were lifted.
After a certain amount is spent, Medicare requires your provider to prove the therapy is medically necessary. In 2021, these amounts are:
- $2,110 for physical therapy and speech-language pathology
- $2,110 for occupational therapy
Under Medicare Part B, you pay 20 percent of the Medicare-approved amount for physical therapy services, and the Part B deductible applies.
Outpatient therapy includes therapy received at:
- Therapists’ or doctors’ office
- Comprehensive Outpatient Rehabilitation Facilities
- Skilled nursing facilities
- Your home, if you’re ineligible for Medicare’s home health benefit
Medicare Advantage plans will cover the same amount as Original Medicare, with some plans covering even more.
The importance of physical therapy
A study by The Moran Company shows that Medicare patients recently diagnosed with lower back pain who received physical therapy as their first treatment lowered their health insurance costs and improved their physical function when compared to receiving injections or surgery as the first intervention. With 80 percent of the U.S. adult population experiencing lower back pain, these findings could make a big difference in the way we view healthcare coverage.
How physical therapy can prevent extra medical costs
Staying active can reduce pain and keep you healthier throughout your life. Physical therapy and other forms of exercise are very important for the prevention of disease and injury. Physical therapy is used to treat several ailments, including falls, osteoporosis, arthritis, Parkinson’s, stroke, dementia, incontinence, and balance problems. Simply building strength and flexibility is key to being able to get around, keep fit, and prevent decline.
According to Physical Therapy Assistant and Therapy Case Reviewer Carrie Lewis of myNEXUS, many people compensate after hip or knee replacements by sitting or walking differently, causing their alignment to be off and resulting in lower back pain.
“Addressing the issue early on with easy leg and back stretches could have prevented the lower back pain,” she says. “Also core strengthening and stabilization, and lower extremity strengthening are important. It’s all connected.”
Movement and stretching as you age
Lewis cites inactivity and education as two of the key issues with older patients. People tend to become more sedentary as they age, and also there is a learning curve involved in educating seniors on stretching, as flexibility wasn’t recognized as important as it is today when they were growing up.
“Staying active is huge in avoiding back pain,” Lewis reiterates. “Anything as simple as a daily walk or stretching can help with that. Surgery, injection, and medicine are always things you would like to avoid, so that is why exercise and strengthening are so beneficial.”
With falls being such a common occurrence in the elderly, and one of the major precursors to physical therapy, the Centers for Disease Control and Prevention offers some advice for preventing falls, such as taking Vitamin D, removing obstacles in your home, and having your vision checked.
In addition to seeking physical therapy, the Mayo Clinic offers some simple back stretches to ease lower back pain and reduce the need for surgery. A little bit of movement now could save a lot of pain and cost later.