Does Medicare Cover Physical Therapy at Home?

Yes. Medicare does cover physical therapy at home. Here in the US, most insurance companies will cover home health services that include physical therapy, occupational therapy, speech therapy, skilled nursing care, and social work services. Many home health agencies will also have home health aide services to help with bathing, grooming, and dressing and also the services of a registered dietician if there are questions about a special diet or issues surrounding nutritional needs.

In short, you’ll need to get a doctor’s prescription for physical therapy to address a “specific issue”, find a home care company or a mobile physical therapist who is able to bill your insurance company, an understanding that the services will only be for a specific/limited time, and that the clinician will need to full participation of the patient and/or their caregiver(s) to implement the “plan of care” once it’s established.

Does Medicare Part A Cover Physical Therapy?

Home health services as mentioned above, does bill Medicare Part A for reimbursement. Many refer to Part A as “hospital insurance,” because it covers you for any inpatient hospital stays. Medicare A also pays for skilled nursing home stays, skilled home health services and hospice care. The coverage for Part A is usually automatic for anyone who has paid into the Medicare system through the payroll taxes from their job if they worked at least 10 years.

There is some confusion about this but, Medicare Part B also provides coverage for home physical therapy services. Part B usually reimburses for what are considered “out patient services” where an individual goes travels to an outpatient clinic.

However, since the COVID-19 pandemic began, there are a growing number of licensed physical therapists that provide in home physical therapy. During the height of the pandemic, it wasn’t safe for anyone, the elderly especially, to gather in groups or public areas without the risk of getting sick. To address this problem, more and more physical therapists have begun to provide tailored treatments for individuals who find it more convenient to stay in their own homes rather than travel to an outpatient clinic

How Can I Get PT at Home

Locate a home health agency or mobile physical therapist that can bill your insurance company for payment and have your doctor send them a prescription for physical therapy services.

Keep in mind that Medicare, and hence other insurances have specific criteria to qualify for home physical therapy and want to know that the services are considered “reasonable and necessary”. This is true for Parts A & B. But meeting these criteria is easily done for the majority of people who have Medicare and want in home physical therapy services.

It’s important for you to understand and remember that the main purpose for home physical therapy is to help “restore or improve function” in the individual receiving therapy services. This is what is considered “reasonable and necessary”. If there is no possibility of improving a person’s functional ability, then most insurances will not cover these in home services.

What Does Medicare Require For Home Physical Therapy

Naturally, as mentioned above, they would need a referral from a doctor. The more specific criteria prescribed, the better. For instance “Physical therapy to evaluate, educate and treat for bed mobility and transfer training using a slide board“, or, “physical therapy to evaluate and treat for impaired balance, and fall risk, 2 times a week for 3 weeks”. Each of these prescriptions are specific and give the therapist and the insurance companies a pretty concise scope of the treatment needed.

Like the example prescriptions above, the therapist’s treatment plan needs to be “specific, safe, and effective treatment” for whatever condition you’re being referred for. For instance, if you’ve had a total knee replacement and you’re trying to increase your range of motion, or, if you’ve had 1 or more falls and you (or your caregiver) need specific instruction on how to recover from a fall. These are “specific” needs that a physical therapist can help with.

Another criteria that Medicare uses is if the services are “complex”. Meaning that your condition requires treatment that can only be safely and effectively performed by, or under the supervision of, a licensed physical therapist. An example of this may be if a person has had a shoulder surgery and a shoulder sling or immobilizer is to be worn. Also, the surgeon wants only specific movements to be performed and you need a PT to instruct and guide you through them. This is considered “complex”.

Also, the actual amount, frequency, and duration of the home physical therapy services need to be “reasonable” meaning a reasonable amount of visits to accomplish the goal of physical therapy. For instance, if a person can already move about their home easily and independently, a therapist who is seeing this patient 3 times a week for 4 weeks is “unreasonable” and so these services will not be covered.

But, if you’re seeing this person once a week for 4 weeks to modify a strengthening exercise program, then that plan of care is “more reasonable”.

Another scenario that Medicare may consider “unreasonable” is if the patient who has dementia, is seen by the physical therapist to instruct them in a mobility or exercise program. Medicare may see this in a negative light as it is difficult for a patient with dementia to “learn” and “remember” what is being taught. In this case the home physical therapist’s plan of care would be to instruct the caregiver in ways to supervise and administer the exercise program. This would be considered “reasonable” and also would meet the “specific” and “complex” requirements also.

Being able to receive physical therapy services in the home is important for those who want to age in place in their own homes. Having a therapist instruct in a home exercise program, assess and recommend the best in home equipment, and teach caregivers the best ways to help people mobilize safely in their homes is something more should take advantage of.

In summary, yes, Medicare does cover home physical therapy services. Medicare A covers physical therapy from a home health care company and Medicare B covers “out patient services” from a mobile physical therapist. You’ll need your doctor to prescribe therapy services that are for a specific issue and need to be performed safely and effectively by, or under the supervision of a licensed physical therapist. And the plan of care, including the frequency and duration, needs to be of a “reasonable” nature.