“Physical therapists are movement experts,” says Roger Hare. American Physical Therapy Association (APTA) Chairman. It's especially important for older adults because of this Half of the physical therapy patients Are over 65 years of age – and this number is expected to grow as the population ages.
As part of their scope of practice, physical therapists provide assessment, counseling, education and therapy to improve balance, mobility, strength, endurance, coordination and flexibility, Hare says.
Common conditions treated with physical therapy include osteoporosis, lower back pain, and urinary incontinence.
“Physical therapy can also be helpful as a preventive measure, such as when you feel vibration in your feet to prevent a fall, or it can help with your recovery after a fall or surgery,” Hare says.
Medicare coverage for physical therapy services
Whether you are staying in a facility, such as a hospital or nursing home, or at home, and need physical therapy, Medicare provides coverage To manage a chronic condition, such as multiple sclerosis (MS), treat an injury or illness, or ensure you can maintain your independence. Although an order or referral is not required under Medicare, a physician, nurse practitioner, clinical nurse specialist, or physician assistant must certify that the services are medically necessary.
Medicare Part A Will Full coverage of inpatient physical therapy to The first 60 days after the deductible is met, provided that skilled nursing and/or rehabilitation services are required daily. After that, co-payments apply.
outpatient clinic coverage, Which includes visits to a physical therapy clinic, or at home for non-homebound seniors, is covered by Medicare Part B. After the annual deductible is met, 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 more services.
“Physical therapy coverage through Medicare changed in 2018,” says Diane Amdahl, the book's author. Medical care for you and co-founder of Medicare Consulting 65 Incorporated.
“Before that, there were limits to coverage. The rule changed to unlimited Medicare coverage for medically necessary outpatient physical therapy services each calendar year.
Medicare Advantage coverage for physical therapy services
“Medicare Advantage plans may require prior authorization before approving your physical therapy treatment,” Hare says. Your physical therapist may need to perform an evaluation and submit a treatment plan to get approved for coverage, Hare 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 networks and/or conduct more frequent audits or reviews to reduce costs and reduce overuse of services, Hare says.
Medicaid coverage for physical therapy services
Medicaid coverage for physical therapy services is Optional benefit depending on your stateso you'll need to check to see what Benefits offered by your state.
Coverage of occupational therapy and speech-language pathology
In addition to physical therapy, Medicare, Medicare Advantage, and Medicaid generally provide the same coverage for other rehabilitation treatments as long as they are deemed medically necessary, Hare says.
This includes Exercise therapyor assist you with performing activities of daily living (such as bathing or dressing), managing the home, and reentering the community to maintain current or slowly decline abilities.
Also includes Speech-Language Pathologywhich provides support to help with speech, language, swallowing, and cognitive skills to maintain, improve, or slow deteriorate current function.
Outpatient physical therapy in a facility or at home – which is better?
All outpatient treatments are covered by Medicare Part B, but you may wonder if getting physical therapy at home is as beneficial as treatment provided at a facility.
“Physical therapy sites may have additional equipment and resources than what a physical therapist can provide at home,” Hare says.
Additionally, Hare says the wait for physical therapy services at the facility may be less than those provided at home.
“Going out for physical therapy also helps with socialization, which can be hindering when dealing with a mobility issue,” Hare says.
However, for some patients, outpatient treatment at home provides an opportunity to address environmental challenges at home and ensure the individual is able to manage safely and independently in their own environment. Hare says home therapy also improves access to treatment for those who don't have reliable transportation.
Difficulty finding physical therapists
Although Medicare covers physical therapy, it can be difficult to find a physical therapist.
“The physical therapy shortage peaked during the pandemic, but we are still seeing double-digit job openings,” Hare says.
Other factors continue to contribute to the ongoing shortage, according to a KFF news report. The first is that physical therapists are now required to obtain a doctorate degree, so fewer students are entering the field. The other reason is that Medicare has reduced physical therapy compensation by 9% over the past four years, resulting in lower staffing levels.
