Your Medicare Coverage

Is my test, item, or service covered?

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How often is it covered?

Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical and occupational therapy, and speech-language pathology services. There are limits on these services when you get them from most outpatient providers. These limits are called “therapy caps.”

You may qualify to get an exception so that Medicare will continue to pay its share for your services after you reach the therapy cap limits. Your therapist must document your need for medically-necessary services in your medical record, and your therapist’s billing office must indicate on your claim for services above the therapy cap that your outpatient therapy services are medically necessary.

Even if your therapist provides documentation that your services were medically necessary, you might still have to pay for costs above the $1,880 therapy cap limits. If Medicare finds, at any time (even after your therapy services have been paid for), that the services above the therapy cap limits weren’t medically necessary, you might have to pay for the total cost of the services above the $1,880 therapy cap limits.

Who's eligible?

All people with Medicare are covered if Medicare finds that the services are medically necessary. Medicare will pay its share for therapy services until the total amounts paid by both you and Medicare reaches either one of the therapy cap limits. Amounts paid by you may include costs like the deductible and coinsurance.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Related resources

Get more information about therapy caps