Does Medicare Cover Physical Therapy in 2026?

Full answer: Yes. Medicare Part B covers outpatient physical therapy in 2026 when a physician or qualified provider certifies it is medically necessary and documents a plan of care. You pay a 20% coinsurance after meeting the $283 Part B deductible (2026), and there's no hard annual visit cap, though therapists must add extra documentation once billed charges pass the $2,480 KX modifier threshold (2026). Medicare Advantage plans must cover the same therapy but often use copays and prior authorization instead.

Physical therapy helps millions of Medicare beneficiaries recover mobility after joint replacements, strokes, falls, and chronic conditions like arthritis, and skipping it can mean a longer hospital stay or a fall that lands someone back in the emergency room. Medicare covers physical therapy in 2026, but how much you pay and which rules apply depend on whether you have Original Medicare, a Medicare Advantage plan, or a Medigap policy.

This guide breaks down exactly what Original Medicare Part B pays for outpatient physical therapy in 2026, how the KX modifier threshold works now that the old therapy cap is gone, what changes under Medicare Advantage, and what physical therapy costs if you have no supplemental coverage at all. For occupational, speech, and mental health therapy coverage, see does Medicare cover therapy. Check your total Medicare costs with the medical bill analyzer.

Coverage Breakdown

Coverage by type
Plan Type	Outpatient PT Coverage	2026 Cost-Sharing	Key Limits
Original Medicare (Part B)	Covers medically necessary outpatient PT ordered by a physician	20% coinsurance after the $283 Part B deductible (2026)	No hard visit cap; KX modifier required above $2,480 (2026)
Medicare Advantage	Must cover everything Original Medicare covers for PT	Flat copay per visit, commonly $10 to $50 (2026)	Prior authorization and in-network therapist often required
Medigap (Medicare Supplement)	Pays Part B coinsurance; adds no new PT benefit	Plan G pays the full 20% coinsurance after the Part B deductible (2026)	Only pairs with Original Medicare, not Medicare Advantage
Self-pay (no supplemental coverage)	Not insurance; applies to non-covered or maintenance therapy	$75 to $150 per session out of pocket (2026)	Applies when Medicare deems therapy not medically necessary

Medicare Advantage plans cannot cover physical therapy less generously than Original Medicare, but cost-sharing structure and network rules vary by plan. Medigap only supplements Original Medicare's cost-sharing; it does not replace the need for a physician's medical necessity certification.

Source: Medicare.gov Physical Therapy Services 2026, CMS CY 2026 Therapy Threshold Update, CMS 2026 Medicare Parts A & B Premiums and Deductibles

Direct Answer

Yes. Medicare Part B covers outpatient physical therapy in 2026 when a physician or qualified provider certifies it is medically necessary and documents a plan of care. You pay a 20% coinsurance after meeting the $283 Part B deductible (2026), and there's no hard annual visit cap, though therapists must add extra documentation once billed charges pass the $2,480 KX modifier threshold (2026). Medicare Advantage plans must cover the same therapy but often use copays and prior authorization instead.

What Original Medicare Part B Covers for Physical Therapy in 2026

Original Medicare covers outpatient physical therapy under Part B whenever a physician, nurse practitioner, or physician assistant certifies that treatment is medically necessary to restore function after an injury, surgery, or chronic condition like arthritis or stroke. Coverage applies whether therapy happens in a private clinic, hospital outpatient department, or physician's office, as long as the therapist is enrolled in Medicare and follows a written plan of care that the physician reviews at least every 90 days.

Medicare Part B pays 80% of the Medicare-approved amount for each visit after you meet the 2026 Part B deductible of $283, leaving you responsible for the remaining 20% coinsurance. The federal therapy cap was eliminated permanently by the Bipartisan Budget Act of 2018, so a beneficiary recovering from a hip replacement can continue therapy for as long as a doctor documents continued medical necessity.

Medicare Part D drug plans do not pay for physical therapy visits, since Part D only covers prescription drugs; any medication prescribed alongside therapy, such as pain relievers, is billed separately through your Part D plan.

The 2026 Outpatient Therapy Threshold and KX Modifier

CMS sets an annual per-beneficiary threshold that flags claims for extra documentation rather than cutting off coverage. For 2026, that threshold is $2,480 in combined billed charges for physical therapy and speech-language pathology services, and a separate $2,480 threshold applies to occupational therapy. Once a beneficiary's therapy charges cross either amount, the therapist must attach a KX modifier to every claim confirming the services remain medically necessary.

A second, higher threshold triggers targeted medical review instead of just documentation. CMS has held the targeted review threshold at $3,000 for combined PT and SLP services (and a separate $3,000 for OT) every year from 2018 through 2028, so claims above that level face a higher chance of an audit request for records. Neither threshold denies care outright; both exist to confirm continued medical necessity in the chart.

What Medicare Advantage Plans Add or Change for Physical Therapy

Medicare Advantage plans must cover at least the same outpatient physical therapy benefit Original Medicare covers, since federal law requires MA plans to match Part A and Part B benefits. Most Medicare Advantage plans replace the 20% coinsurance with a flat copay per visit, commonly $10 to $50 in 2026, which can lower costs for beneficiaries who need frequent sessions.

Medicare Advantage plans commonly add rules Original Medicare does not use: prior authorization before the first visit, a requirement to use in-network therapists, and periodic re-authorization if treatment continues past a set number of visits. Some Medicare Advantage plans also include supplemental fitness benefits like SilverSneakers, but those wellness programs are separate from clinically ordered physical therapy and do not substitute for it.

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Physical Therapy Under Part A: Skilled Nursing Facilities and Home Health

Skilled nursing facility stays pay for physical therapy under Medicare Part A when a beneficiary has a qualifying 3-day inpatient hospital stay and needs daily skilled therapy afterward. Medicare covers the first 20 days in full during a benefit period, then charges a $217 daily coinsurance for days 21 through 100 in 2026, and the beneficiary pays the full cost after day 100.

Home health physical therapy is covered under Medicare Part A and Part B with no coinsurance or deductible when a physician certifies the beneficiary is homebound and needs skilled, intermittent therapy. A Medicare-certified home health agency must provide the care, and the physician must recertify the plan of care periodically to keep the visits covered.

Medigap and the Cost of Physical Therapy Without Supplemental Coverage in 2026

Medigap policies do not add new physical therapy benefits; they only pay some or all of the Part B coinsurance and deductible that Original Medicare leaves behind. Plan G, the most popular Medigap plan sold to new enrollees in 2026, covers the full 20% coinsurance on outpatient therapy after you pay the annual Part B deductible, so out-of-pocket costs for covered therapy drop close to zero.

Beneficiaries without Medigap or a Medicare Advantage plan pay the 20% coinsurance themselves, and physical therapy that Medicare does not consider medically necessary, such as ongoing maintenance or wellness sessions, is billed at the clinic's full self-pay rate. Self-pay outpatient physical therapy sessions typically cost $75 to $150 per visit in 2026 according to industry billing data, well above the Medicare coinsurance for a covered visit.

How to Find a Medicare-Approved Physical Therapist

Medicare.gov's Care Compare tool lets beneficiaries search for enrolled physical therapy providers by ZIP code and confirm a clinic accepts Medicare assignment before scheduling the first visit. Beneficiaries on Original Medicare can see any Medicare-enrolled therapist without a referral in most states, though some states require a physician referral by law.

Beneficiaries on a Medicare Advantage plan should call member services before the first visit to confirm which in-network therapists are covered and whether prior authorization is required, since starting therapy with an out-of-network provider can mean paying the full cost. Keeping a copy of the physician's written order and the therapy plan of care also speeds up authorization and reduces billing disputes.

Frequently Asked Questions

Does Original Medicare cover physical therapy?

Yes. Original Medicare Part B covers outpatient physical therapy in 2026 whenever a physician or qualified provider certifies it is medically necessary and documents a plan of care. You pay a 20% coinsurance after the $283 Part B deductible (2026). There is no hard annual visit limit, though extra documentation is required once billed charges pass the $2,480 KX modifier threshold for 2026.

Does Medicare Advantage cover physical therapy?

Yes. Medicare Advantage plans must cover at least the same outpatient physical therapy benefit as Original Medicare because federal law requires MA plans to match Part A and Part B coverage. Most plans replace the 20% coinsurance with a flat copay, often $10 to $50 per visit in 2026, but commonly add prior authorization and in-network therapist requirements Original Medicare does not use.

Is there a Medicare physical therapy visit limit in 2026?

No hard cap exists. Congress permanently repealed the therapy cap in the Bipartisan Budget Act of 2018. Instead, CMS uses a documentation threshold of $2,480 in billed charges for 2026, above which therapists must add a KX modifier confirming medical necessity, and a separate $3,000 threshold that can trigger a targeted medical record review.

What is the KX modifier and why does it matter for physical therapy?

The KX modifier is a billing code therapists attach to claims once a beneficiary's yearly outpatient therapy charges cross the CMS threshold, $2,480 for combined PT and speech-language pathology in 2026. It confirms the physician has documented that continued therapy remains medically necessary, and it lets Medicare keep paying for medically justified care beyond the threshold.

Does Medicare cover physical therapy at home?

Yes. Home health physical therapy is covered under Medicare Part A and Part B with no coinsurance or deductible when a physician certifies the beneficiary is homebound and needs skilled, intermittent therapy from a Medicare-certified home health agency. The physician must recertify the plan of care periodically to keep the visits covered in 2026.

Does Medicare cover physical therapy in a skilled nursing facility?

Yes, under Part A, after a qualifying 3-day inpatient hospital stay. Medicare covers the first 20 days of a skilled nursing facility stay in full, then charges a $217 daily coinsurance for days 21 through 100 in 2026. Beyond day 100 in a benefit period, the beneficiary pays the full cost of care.

How much does physical therapy cost without Medicare coverage in 2026?

Self-pay outpatient physical therapy typically costs $75 to $150 per session in 2026 according to industry billing data, well above the Medicare coinsurance for a covered visit. This applies mainly to maintenance or wellness therapy that Medicare does not consider medically necessary, since medically necessary therapy is covered under Part B.

Does Medigap cover physical therapy copays?

Medigap policies do not add a new physical therapy benefit; they pay some or all of the 20% Part B coinsurance that Original Medicare leaves behind. Plan G, the most popular Medigap plan for new enrollees in 2026, covers the full coinsurance on covered outpatient therapy after the Part B deductible is met, reducing out-of-pocket costs close to zero.