Does Medicare Cover Therapy? (2026)

Quick Answer: What Therapy Does Medicare Cover in 2026?

Yes. Medicare covers physical therapy, occupational therapy, speech-language pathology, and outpatient mental health therapy under Part B. After the 2026 Part B deductible of $283, you pay 20% coinsurance with no annual visit cap. Inpatient therapy in a skilled nursing facility or rehabilitation hospital bills under Part A with different cost-sharing. Medicare Advantage plans must cover all the same therapy types and may offer extras.

What Original Medicare Covers for Therapy in 2026

Original Medicare Part B covers outpatient therapy services when a physician or non-physician practitioner certifies that the therapy is medically necessary. The four categories are physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), and outpatient mental health therapy. All four require that services be performed by or under the supervision of a licensed therapist enrolled in Medicare. You do not need a referral from a primary care doctor to see a physical therapist directly, but your therapist must still document that services are medically necessary for Medicare to pay.

Part B also covers several preventive mental health services with no cost-sharing when billed as preventive. Annual depression screening is covered at $0 for Medicare beneficiaries when performed by a primary care provider in a primary care setting. Annual alcohol misuse screening and brief counseling are also covered at $0. Intensive outpatient program (IOP) mental health treatment is covered under Part B since 2024 for beneficiaries who need structured outpatient psychiatric care.

The $2,480 Therapy Threshold and KX Modifier Explained (2026)

Medicare tracks therapy spending through annual thresholds. For 2026, the combined PT and SLP threshold is $2,480. Occupational therapy has its own separate $2,480 threshold tracked independently. These thresholds are not hard caps. When your therapy charges exceed $2,480, your therapist must add a KX modifier to each claim to certify that continued treatment is medically necessary and documented in your plan of care. Therapy continues without interruption as long as the KX modifier is applied correctly and your documentation supports medical necessity.

Above approximately $3,000 in annual therapy charges, a Medicare contractor may initiate a targeted medical review, requesting documentation from your therapist before approving additional claims. This does not stop therapy but creates an administrative review period. Your therapist's documentation of functional goals, measurable progress, and expected outcomes is the key to clearing targeted medical review. If your Medicare Summary Notice shows a therapy claim denied, the first step is to confirm your therapist submitted the KX modifier.

Mental Health Therapy Coverage Under Medicare Part B (2026)

Mental health therapy under Part B expanded significantly starting January 1, 2024. The Consolidated Appropriations Act of 2023 (CAA 2023) added marriage and family therapists (MFTs) and licensed professional counselors (mental health counselors) as Medicare providers for the first time. Previously, only psychiatrists, psychologists, and licensed clinical social workers (LCSWs) could bill Medicare independently for outpatient mental health therapy. As of 2026, all five provider types can deliver and bill for psychotherapy, individual counseling, group therapy, and crisis intervention services under Part B.

Mental health therapy is subject to the same 20% coinsurance and $283 deductible as other Part B services in 2026. The therapy threshold rules that apply to PT, OT, and SLP do NOT apply to mental health therapy. Mental health visits are tracked separately and have no annual spending threshold equivalent to the $2,480 PT/OT/SLP thresholds. Medicare also covers partial hospitalization programs (PHPs) for intensive psychiatric day treatment under Part B when the treating physician certifies that inpatient hospitalization would otherwise be required.

Telehealth Therapy Coverage Through December 31, 2027

Medicare telehealth therapy is available through December 31, 2027, under the Consolidated Appropriations Act of 2026 (CAA 2026), which extended pandemic-era telehealth flexibilities. Physical therapy, occupational therapy, speech-language pathology, and mental health therapy can all be delivered via two-way audio-video platforms. Importantly, CAA 2026 removed the requirement to have an in-person visit before accessing telehealth mental health therapy, which had been a barrier for rural and homebound beneficiaries. You can receive therapy via telehealth from your home as long as the therapist is licensed in the state where you are located.

Audio-only telehealth therapy (phone without video) remains available for mental health therapy through December 31, 2027, for beneficiaries who lack access to video technology. For PT, OT, and SLP, audio-only is generally not sufficient because these therapy types typically require visual assessment of movement, function, or articulation. Cost-sharing for telehealth therapy is the same as in-person therapy: 20% coinsurance after the $283 Part B deductible.

What Medicare Advantage May Add for Therapy in 2026

Medicare Advantage (Part C) plans must cover all therapy services that Original Medicare covers, including PT, OT, SLP, and mental health therapy. Beyond that floor, many Medicare Advantage plans offer enhanced therapy benefits in 2026. Common additions include chiropractic care visits beyond Medicare's standard manipulation-only coverage, acupuncture for chronic low back pain (up to 20 visits per year in some plans), extra PT or OT visits above Original Medicare thresholds without requiring a KX modifier process, and fitness or physical activity program memberships. Use the Medicare Plan Finder at medicare.gov to compare therapy benefits across Medicare Advantage plans available in your zip code for the 2026 plan year.

Inpatient Therapy Under Medicare Part A: SNF and Rehab Hospitals

When therapy is delivered during a skilled nursing facility (SNF) stay or an inpatient rehabilitation facility (IRF) stay, Medicare Part A applies, not Part B. The cost-sharing structure is different. For a SNF stay, Medicare Part A covers days 1 through 20 at $0 cost to you in 2026, then days 21 through 100 require a $217 per day coinsurance payment. After 100 days, Part A SNF benefits are exhausted for that benefit period. For an inpatient rehabilitation facility admission, the 2026 Part A deductible of $1,736 applies per benefit period.

To qualify for Medicare-covered SNF therapy, you must have had a qualifying hospital stay of at least 3 consecutive days (not counting the discharge day) within 30 days of the SNF admission, and the SNF must certify that skilled care is medically necessary. Physical therapy, occupational therapy, and speech-language pathology all qualify as skilled care that can trigger and maintain Medicare SNF coverage. Mental health therapy in a SNF is generally not a separate trigger for SNF benefit eligibility, but it is covered as part of the overall SNF benefit once you qualify.

How to Find a Medicare-Covered Therapist and Start Therapy (2026)

Medicare does not limit you to a specific provider network for Original Medicare. Any therapist who accepts Medicare assignment can treat you. The Medicare Provider Directory at medicare.gov/care-compare lets you search for physical therapists, occupational therapists, speech pathologists, and mental health providers by zip code and specialty. Filter for providers who accept Medicare assignment to avoid balance billing. For Medicare Advantage, you must use the plan's network; the plan's online provider directory or member services line is the correct starting point for network searches.

• Step 1: Confirm your Medicare status. Original Medicare beneficiaries can use any Medicare-accepting provider. Medicare Advantage members must use their plan network.
• Step 2: Search for providers. Use medicare.gov/care-compare and filter by therapy type, zip code, and 'accepts Medicare assignment.'
• Step 3: Get a referral or order if needed. Physicians can write orders for PT, OT, or SLP. Direct access for PT is allowed under Medicare without a physician referral, but the therapist must certify medical necessity independently.
• Step 4: Confirm the therapist is enrolled in Medicare and accepts assignment before scheduling. Ask the front desk directly.
• Step 5: Track your annual therapy spending toward the $2,480 thresholds. Ask your therapist's billing department to notify you when you approach the threshold so the KX modifier is added proactively.

Alternatives and Supplements When Medicare Does Not Cover a Therapy Type

Original Medicare does not cover chiropractic care beyond spinal manipulation, recreational therapy, or fitness programs as standalone benefits. For beneficiaries who need these services or who have exhausted covered therapy visits, several alternatives exist in 2026.

• Medicare Advantage with enhanced therapy benefits: Many Part C plans add chiropractic, acupuncture (up to 20 visits for chronic low back pain in some plans), and extra PT/OT visits. Compare plans during the Annual Enrollment Period (October 15 through December 7, 2026) at medicare.gov.
• Medigap supplemental plans (Plans C, D, F, G, M, N): These cover the 20% Part B coinsurance on all covered therapy services, eliminating out-of-pocket cost for Medicare-approved therapy. They do not expand what is covered, only what you pay.
• Dual-eligible programs (Medicare + Medicaid): The approximately 12 million Americans who qualify for both Medicare and Medicaid can have Medicaid cover Medicare cost-sharing (deductibles, coinsurance), making covered therapy essentially free. Medicaid in most states also covers additional therapy types that Medicare does not.
• State SHIP (State Health Insurance Assistance Program) counselors: Free one-on-one counseling to help you compare Medicare Advantage plans that may offer the enhanced therapy benefits you need. Find your state's SHIP at shiphelp.org.

Does Original Medicare cover physical therapy in 2026?

Yes. Original Medicare Part B covers outpatient physical therapy when medically necessary. After the 2026 Part B deductible of $283, you pay 20% coinsurance with no annual visit cap. When your PT charges (combined with SLP charges) exceed $2,480 in 2026, your therapist must add a KX modifier certifying medical necessity. Above approximately $3,000, a targeted medical review may be triggered, but therapy continues during the review.

Does Medicare cover mental health therapy and psychotherapy in 2026?

Yes. Medicare Part B covers outpatient mental health therapy including individual psychotherapy, group therapy, family therapy, and crisis intervention. As of January 1, 2024, licensed mental health counselors and marriage/family therapists were added as Medicare providers alongside existing providers (psychiatrists, psychologists, LCSWs). The 2026 cost-share is 20% coinsurance after the $283 Part B deductible. Annual depression screening is covered at $0 when performed in a primary care setting.

Does Medicare cover occupational therapy?

Yes. Medicare Part B covers outpatient occupational therapy when medically necessary. The 2026 annual OT threshold is $2,480, tracked separately from the combined PT+SLP threshold. When OT charges exceed $2,480, the KX modifier requirement applies. Cost-sharing is 20% after the $283 Part B deductible. Telehealth OT is available through December 31, 2027.

What is the Medicare therapy threshold for 2026?

For 2026, there are two separate Medicare therapy thresholds. Physical therapy and speech-language pathology share a combined threshold of $2,480. Occupational therapy has its own separate $2,480 threshold. When charges exceed these thresholds, providers must add a KX modifier to certify continued medical necessity. The KX modifier allows unlimited therapy above the threshold as long as medical necessity is documented. These thresholds reset January 1 each year.

Does Medicare cover telehealth therapy sessions?

Yes, through December 31, 2027. The CAA 2026 extended Medicare telehealth coverage for PT, OT, SLP, and mental health therapy. Beneficiaries can receive therapy via two-way audio-video from their home. Audio-only telehealth remains available for mental health therapy specifically through 2027 for those without video access. Cost-sharing for telehealth therapy is the same as in-person: 20% coinsurance after the $283 Part B deductible.

How much does therapy cost with Medicare in 2026?

With Original Medicare in 2026, you pay the $283 Part B annual deductible first (if not yet met), then 20% of the Medicare-approved amount for each therapy session. For example, if Medicare approves $150 for a PT session, you pay $30. There is no annual visit cap. Medigap supplemental plans (F, G, N) cover the 20% coinsurance, making covered therapy essentially free after the deductible. Medicare Advantage plan copays vary by plan, typically $25 to $50 per therapy visit.

Does Medicare cover speech therapy?

Yes. Medicare Part B covers speech-language pathology (SLP) services including evaluation and treatment for swallowing disorders, aphasia, cognitive communication, and voice disorders. SLP charges are combined with physical therapy charges toward the $2,480 annual threshold in 2026. The same KX modifier and targeted medical review rules apply. Telehealth SLP is available through December 31, 2027.

What therapy does Medicare NOT cover?

Medicare does not cover recreational therapy as a standalone outpatient benefit, fitness or gym membership programs, massage therapy as a standalone service, and chiropractic care beyond spinal manipulation for subluxation. Medicare Advantage plans frequently add these benefits. If you need services outside Original Medicare's therapy coverage, use the Medicare Plan Finder at medicare.gov during the Annual Enrollment Period (October 15 through December 7) to compare Medicare Advantage plans that may cover them.