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Does Medicare Cover Outpatient Rehabilitation Therapy?

Medicare Bob
Medicare General Info
While Medicare Part B can cover outpatient rehabilitation therapy, it’s important to know your coverage benefits and out-of-pocket costs if you’re ever in need.
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If you’re involved in an accident, what do you do once you’ve been released from the hospital? Maybe you were in a car crash and needed emergency surgery, or you tripped and fell down the stairs in your house. Once you’re well enough to be discharged from the hospital, you might require outpatient rehabilitation therapy services — like physical therapy or occupational therapy — to move toward a fuller recovery.

Physical therapy could help you regain mobility, while occupational therapy can help you maintain independence by improving everyday skills, such as using cutlery, writing or getting dressed.

Let’s take a look at which services Medicare can cover for outpatient rehabilitation therapy and whether you might expect any copays, deductibles or out-of-pocket costs.

Types of Outpatient Rehabilitation Therapy Services Covered by Medicare

Medicare Part B can cover three types of outpatient rehabilitation services when they are considered medically necessary:

  • Physical therapy: This type of therapy treats injuries and diseases that change your ability to function and helps you improve or maintain your current function while slowing any physical decline.

  • Occupational therapy: This form of therapy helps you perform daily activities and maintain your current capabilities while slowing decline

  • Speech-language pathology therapy: Helps you regain speech and language skills (possibly after a stroke), which may include cognitive and swallowing skills.

Part B applies to services after you're discharged, as well as other kinds of outpatient needs, such as medical equipment, preventative care and mental health screenings.

You could receive outpatient services at a physical therapy center or doctor’s office, a comprehensive outpatient rehabilitation facility, a skilled nursing facility or even at home.

If you require these kinds of therapies while you’re hospitalized or in a rehabilitation facility, they are handled by Medicare’s Part A coverage. Medicare can pay for the first 20 days in a skilled nursing facility. After 20 days, you’ll likely have a coinsurance cost. Medicare does not cover the cost of a skilled nursing facility after 100 days.

In 2022, costs have changed for various aspects of Medicare coverage, so be sure to check your plan. If you have Medicare Advantage, outpatient therapy costs will depend on your specific plan’s coverage.

What To Know About Cost Limits

Medicare doesn’t limit the amount of care you can receive in one calendar year. However, after a certain dollar amount, your providers must confirm your care is medically necessary to continue. In 2022, that total is $2,150 or physical therapy and speech-language pathology combined and $2,150 for occupational therapy.

Once the medical necessity of your care has been confirmed, you may continue to receive outpatient therapy, with Medicare covering up to 80% of the cost.

What To Do When Therapy Is Not Considered Necessary

If your provider decides your therapy is no longer medically necessary, they must let you know so you can decide whether you’ll continue the therapy.

The notification you’ll receive is called an Advance Beneficiary Notice of Noncoverage (ABN). You may be able to continue the therapy if you agree to pay the costs, but Medicare may not help. You can also file an appeal if you believe your therapy should continue. For care that is medically necessary, you’re able to get confirmation documentation so you’re not surprised by unexpected costs later on.

To learn more about outpatient rehabilitation therapy coverage, call 1-833-463-3262, TTY 711 to speak with a licensed agent at Senior Healthcare Direct.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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