Medicare covers therapy services to help you regain or maintain your ability to function. If you meet the requirements below, Medicare should pay for therapy whether you need it on a temporary basis to restore your condition, or you need it on an ongoing basis to prevent you from getting worse. If you meet the requirements below, Medicare should cover your outpatient therapy whether or not your condition is temporary or chronic and whether or not you need therapy to improve or maintain your ability to function.
Medicare will cover outpatient physical, occupational, and speech pathology services if:
- You need therapy and it is considered a safe and effective treatment for you
- This means that you need the technical skills that a trained therapist can provide or oversee
- The therapist must perform the services or direct the staff who perform the services
- Your doctor or therapist sets up the plan of treatment before you get care
- Your doctor regularly reviews the plan of treatment to see if changes are needed
You can get these services as an outpatient in a participating hospital or skilled nursing facility (you must qualify for the skilled nursing facility benefit), or from a participating home health agency (you must qualify for the home health benefit), rehabilitation agency, Comprehensive Outpatient Rehabilitation Facility (CORF) or public health agency. Also, you may be able to get services from a privately practicing, Medicare-approved physical, speech or occupational therapist in his or her office or in your home.
In 2014, Medicare will cover up to $1,920 for physical and speech therapy combined, and another $1,920 for occupational therapy. If you are approaching the limit and need more therapy, your doctor can tell Medicare that it’s medically necessary for you to continue. Medicare is most likely to cover additional therapy if your case is medically complicated. If Medicare denies the claim, you can appeal through the Original Medicare appeals process.