While there are many write-ups regarding Medicare physical therapy billing, we will provide you with a quick and short guide to address all your issues. If you wish to know more, we advise you to connect with our advisors on AskHPM immediately.

Medicare physical therapy billing is one of the most frequently asked questions online. While it is important to note every nuance about Original Medicare and Medicare Advantage Plans, you also need to ensure the coverage provided and the details therein.

Let us quickly give you a snapshot of all the essential points regarding physical therapy billing under Medicare

  • Original Medicare will only pay for physical therapy to a licensed physiotherapist or doctor if it considers it medically necessary. For example- accident injuries, chronic conditions like Parkinson’s disease, recovery from a stroke or fall, etc.
  • Medicare Part A, i.e., hospital insurance, and Part B, i.e., outpatient treatment, may cover these services depending on the current circumstances and setting. It also holds for speech and occupational therapy.
  • Medicare Part A may pay for part of the expenses if you are in an inpatient rehab facility.
  • Medicare Part B may cover outpatient physical therapy billing if you undergo the same in a therapists’ office, outpatient rehab facility, hospital OPD, skilled nursing facility, or at home under the guidance of a Medicare-certified home health agency.
  • For outpatient therapy, you will need to incur 20% of the Medicare-approved amount. Part B deductible is applicable and will come into effect once you pay your deductibles for the year.
  • Any treatment advised by a doctor is covered, but not one recommended by a physiotherapist.

It is a brief overview of the ifs and buts of Medicare physical therapy billing. We advise you to speak with any of the health plan advisors on www.askhpm.com to know more.