Medicare Part B covers outpatient therapy, including physical therapy Physical therapy is exercise and physical activities used to condition muscles and regain movement and strength in a body area. It is helpful to improve or restore physical function for those with debilitating illness or injury. (PT), speech-language pathology Speech-language pathology, also known as speech therapy and language therapy, is treatment to regain and strengthen speech and language skills. (SLP), and occupational therapy Occupational therapy is therapy that helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. (OT). Previously, there were limits, also known as the therapy cap, how much outpatient therapy Original Medicare covered annually. However, in 2018, the therapy cap was removed.
Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. When you receive services from a participating provider In Original Medicare, a participating provider is a health care provider who accepts Medicare and always takes assignment. They may not charge you more than Medicare’s approved amount. If you have Original Medicare and see a participating provider, you will pay a 20% coinsurance for Medicare-covered services. See also: Non-Participating Provider. , you pay a 20% coinsurance after you meet your Part B deductible ($257 in 2025).
If your total therapy costs reach a certain amount, Medicare requires your provider to confirm that your therapy is medically necessary. In 2025, Original Medicare covers up to:
- $2,410 for PT and SLP before requiring your provider to indicate that your care is medically necessary
- And, $2,410 for OT before requiring your provider to indicate that your care is medically necessary
Remember, Medicare pays for up to 80% of the Medicare-approved amount. This means Original Medicare covers up to $1,928 (80% of $2,410) before your provider is required to confirm that your outpatient therapy services are medically necessary. If Medicare denies coverage because it finds your care is not medically necessary, you can appeal.
Keep in mind that outpatient therapy includes therapy received:
- At therapists’ or doctors’ offices
- At Comprehensive Outpatient Rehabilitation Facilities (CORFs)
- At skilled nursing facilities (SNFs), when you are there as an outpatient or are otherwise ineligible for a Medicare-covered stay
- And, at home through therapists connected with home health agencies, when you are ineligible for Medicare’s home health benefit
Medicare’s coverage rules for outpatient therapy do not apply if you are receiving therapy as part of a Medicare-covered SNF stay or if you are receiving Medicare-covered home health care Home health care is care provided at home to treat an illness or injury. Medicare will only cover home health care if you are homebound and have a need for skilled care, including skilled nursing and/or skilled therapy services. .