Does Medicare Cover Physical Therapy? 2026 Costs and Rules

Is physical therapy covered by Medicare?

Yes. Medicare covers physical therapy in several settings, but the coverage rules and your out-of-pocket costs depend on where you receive care. The key requirement is the same everywhere: the therapy must be medically necessary to evaluate or treat your condition, and a doctor or an allowed provider (a nurse practitioner, clinical nurse specialist, or physician assistant) must certify that you need it.

Most outpatient PT, the kind you get at a clinic, a therapist's office, or as a hospital outpatient, falls under Medicare Part B. Physical therapy that happens during a hospital or rehab stay, in a skilled nursing facility, or as part of home health care falls under Medicare Part A. Each part has its own deductible and cost-sharing, which we cover below.

• Outpatient PT (clinic, office, hospital outpatient): covered under Part B
• Inpatient rehabilitation and skilled nursing facility PT: covered under Part A
• Home health PT for homebound patients: covered under Part A or Part B
• A doctor or allowed provider must certify the therapy is needed

What does outpatient physical therapy cost in 2026?

For outpatient PT under Part B, you pay 20% of the Medicare-approved amount after you meet your annual Part B deductible. In 2026 that deductible is $283 for the year, so you cover the first $283 of Part B services yourself before coinsurance starts. After that, Medicare pays 80% of the approved amount for each covered PT service and you pay the remaining 20%.

To keep Part B (which is what pays for outpatient PT), most people pay a standard monthly premium of $202.90 in 2026. A Medigap (Medicare Supplement) policy can pick up the 20% coinsurance, and a Medicare Advantage plan replaces this structure with its own copays, which we explain further down.

• 2026 Part B deductible: $283 per year before coinsurance begins
• Your share after the deductible: 20% of the Medicare-approved amount
• Medicare's share: 80% of the approved amount
• 2026 standard Part B premium to keep Part B: $202.90 per month

Is there a limit or cap on physical therapy?

There is no hard annual dollar limit, sometimes called a 'therapy cap,' on medically necessary outpatient PT. The old caps were eliminated, so Medicare keeps paying its share as long as the therapy remains medically necessary and is documented.

There are, however, two dollar thresholds to be aware of. The first is the KX modifier threshold. In 2026, once your physical therapy combined with speech-language pathology reaches $2,480, your therapist must attach a 'KX modifier' to the claim. This is simply a confirmation that the services are still medically necessary; it is not a denial, and it does not stop your coverage. Occupational therapy has its own separate $2,480 threshold for 2026.

The second is the targeted medical review threshold of $3,000, which is held at that level through CY 2028. Claims above this amount may, but will not always, be reviewed for medical necessity. Neither threshold limits how many sessions Medicare will pay for; the deciding factor is whether the care is still medically necessary, which is why your doctor's order and the therapist's documentation matter.

• No hard cap on medically necessary outpatient PT
• 2026 KX modifier threshold: $2,480 for PT and speech therapy combined
• 2026 KX modifier threshold: $2,480 for occupational therapy (separate)
• Targeted medical review threshold: $3,000 (held through CY 2028)

Physical therapy as an inpatient, in a nursing facility, or at home

When PT is part of an inpatient rehabilitation or hospital stay, it is covered under Part A. Part A is premium-free for most people who worked and paid Medicare taxes for at least 40 quarters. You first pay the Part A inpatient deductible of $1,736 per benefit period in 2026. After that, your daily coinsurance is $0 for days 1 through 60, $434 per day for days 61 through 90, and $868 per day for lifetime reserve days 91 through 150.

Physical therapy in a skilled nursing facility (SNF) is also under Part A. In 2026 you pay $0 per day for days 1 through 20, then $217 per day for days 21 through 100. SNF coverage generally requires a qualifying prior hospital stay.

Physical therapy delivered as part of Medicare-approved home health care costs you nothing for the therapy itself. To qualify, you must be homebound, need skilled therapy, have a doctor's order, and be under a care plan that is regularly reviewed by a Medicare-certified home health agency.

• Inpatient rehab (Part A): $1,736 deductible per benefit period; $0/day days 1-60; $434/day days 61-90; $868/day lifetime reserve days
• Skilled nursing facility (Part A): $0/day days 1-20; $217/day days 21-100
• Home health PT: $0 for the Medicare-approved therapy
• Home health requires: homebound status, skilled need, doctor's order, and a reviewed care plan from a certified agency

Advantage plans, Medigap, and other therapies

Medicare Advantage (Part C) plans must cover everything Original Medicare covers, including physical therapy. However, the plan sets its own copays, coinsurance, network rules, and prior authorization requirements. That means your cost per visit and any approval steps can differ from Original Medicare. Always check your plan's Evidence of Coverage and confirm whether you need a referral or prior authorization before starting PT.

If you have Original Medicare, a Medigap (Medicare Supplement) policy can help pay the 20% Part B coinsurance for outpatient PT, and depending on the plan it may cover Part A and Part B deductibles too. Coverage varies by Medigap plan letter, so review what your specific plan pays.

Medicare covers occupational therapy and speech-language pathology under the same Part B framework as PT, including the medical-necessity rule and the KX modifier thresholds described above. Medicare also covers PT for chronic conditions and maintenance therapy when a skilled therapist is needed to maintain your condition or slow decline, not only when you are expected to improve.

• Medicare Advantage must cover PT, but copays, networks, and prior authorization are set by the plan; confirm in your Evidence of Coverage
• Medigap can cover the 20% Part B coinsurance; what it pays varies by plan letter
• Occupational and speech therapy are covered under the same Part B rules as PT
• Maintenance therapy can be covered when skilled care is needed to maintain function