Medicare does cover physical therapy in 2026, and for most beneficiaries the cost is manageable. The catch is understanding which part of Medicare applies, what the $2,480 KX modifier threshold means for ongoing treatment, and how much you will owe out of pocket per session. This guide breaks down every scenario so you know exactly what to expect before your first appointment.
Which Part of Medicare Covers Physical Therapy?
The answer depends on where you receive care.
Medicare Part B covers outpatient physical therapy. This is the most common setting. If you go to a private PT clinic, a hospital outpatient department, or a rehab center as an outpatient, Part B applies. It also covers physical therapy provided in your home when Medicare considers you homebound.
Medicare Part A covers physical therapy delivered inside a skilled nursing facility (SNF) as part of an inpatient stay. Part A does not cover standalone outpatient PT.
Medicare Advantage (Part C) plans must cover at least as much as Original Medicare, but many plans add extra sessions or lower copays. Prior authorization requirements vary by plan, so check your plan documents before starting a course of treatment.
Medicare Part B Physical Therapy: 2026 Cost Breakdown
For outpatient PT under Part B, the standard cost-sharing works like this:
| Cost Component | 2026 Amount |
|---|
| Part B annual deductible | $257 |
| Your coinsurance after deductible | 20% of Medicare-approved amount |
| Medicare pays | 80% of Medicare-approved amount |
| Typical session cost (your share) | $20 to $70 per visit |
The Part B deductible is $257 for 2026. Once you meet it, you pay 20% of the Medicare-approved amount for each PT session. Actual session costs vary by the type of service billed, but most outpatient PT visits result in $20 to $70 in cost-sharing per visit.
There is no annual cap on the number of sessions. Medicare eliminated therapy caps permanently in 2018. However, there is a spending threshold that triggers additional documentation requirements.
The $2,480 KX Modifier Threshold Explained
In 2026, the outpatient therapy threshold is $2,480 for physical therapy and speech-language pathology combined. This is not a spending cap. It is a documentation trigger.
Once Medicare has paid its share and your total PT claims (what Medicare paid plus your 20%) reach $2,480, your provider must add a billing modifier called the KX modifier to every subsequent claim. The KX modifier is the provider's written attestation that continued therapy is medically necessary and that documentation in your chart supports it.
If your provider does not add the KX modifier past the threshold, Medicare will automatically deny those claims. You would then owe the full cost. Ask your PT clinic whether they are tracking your cumulative therapy spending if you are on a longer course of treatment.
A separate $6,350 threshold applies, above which claims may be selected for a medical review audit. This affects billing but does not change your cost-sharing.
Medicare Part A Physical Therapy: SNF Coverage in 2026
If a hospital stay leads to a skilled nursing facility placement, Medicare Part A covers PT as part of your SNF benefit. The rules:
- You must have a qualifying inpatient hospital stay of at least 3 days (the discharge day does not count).
- Medicare covers up to 100 days per benefit period in a SNF.
- Physical, occupational, and speech therapy are included in the SNF benefit.
| SNF Days | What You Pay (2026) |
|---|
| Days 1 to 20 | $0 (after the $1,736 Part A deductible) |
| Days 21 to 100 | $217.50 per day |
| Day 101 and beyond | All costs |
The Part A deductible is $1,736 per benefit period in 2026. After day 20, the daily copay of $217.50 adds up quickly for extended stays.
Home Health Physical Therapy Under Medicare
Medicare covers PT in your home if your doctor certifies that you are homebound. Homebound means leaving home requires a considerable effort, such as using a wheelchair or needing assistance from another person.
Home health PT falls under Part A or Part B depending on how it is arranged through a certified home health agency. There is no cost-sharing for approved home health services. You pay nothing for the PT visits themselves, though you still pay 20% for any durable medical equipment your therapist orders.
Requirements for home health PT coverage:
- Your doctor must certify the need and create a plan of care.
- The home health agency must be Medicare-certified.
- You must be homebound.
- The therapy must be medically necessary.
What Medicare Does Not Cover for Physical Therapy
Medicare will not pay for PT that is considered maintenance-level care. If your condition has plateaued and therapy is simply maintaining your current function rather than improving it, Medicare may deny the claim. Your therapist should document that you are making measurable progress toward treatment goals.
Medicare does not cover:
- Routine wellness or fitness programs
- Massage therapy when billed separately (not as part of a medically necessary PT session)
- Physical therapy ordered by a provider who is not enrolled in Medicare
- PT at a facility that is not Medicare-certified
How Medicare Advantage Affects PT Coverage
Medicare Advantage plans must cover all Original Medicare benefits, but the cost structure can differ significantly from Original Medicare. Common differences:
- Copays instead of coinsurance: Many plans charge a flat $25 to $50 copay per PT visit rather than 20%.
- Prior authorization: Many Advantage plans require approval before you start PT, especially for more than a set number of visits.
- Network restrictions: You may need to see an in-network provider or pay a higher out-of-pocket rate.
- Extra benefits: Some plans cover more sessions per year than Original Medicare's unlimited-but-threshold-based model.
The 2026 maximum out-of-pocket limit for in-network services under Medicare Advantage plans is $9,350. If your PT costs approach that limit, the plan covers 100% of the rest of your costs for the year.
Reducing Your Out-of-Pocket PT Costs
Medigap (Medicare Supplement) plans can eliminate most of your PT cost-sharing under Original Medicare.
| Medigap Plan | What It Covers for PT |
|---|
| Plan G | Covers the 20% coinsurance after you pay the $257 deductible |
| Plan N | Covers the 20% coinsurance but charges up to $20 per office visit |
| Plan F (pre-2020 enrollees only) | Covers deductible and coinsurance, leaving you with $0 per session |
With Medigap Plan G, once you pay the $257 annual deductible, your out-of-pocket cost for covered PT sessions drops to essentially zero for the rest of the year.
Medicare Savings Programs can help if your income is limited. These programs, run by states, help low-income Medicare beneficiaries pay their Part B premiums, deductibles, and coinsurance. The Qualified Medicare Beneficiary (QMB) program, for example, covers Part B coinsurance for services including physical therapy. If you qualify, you would owe nothing for your PT visits.
To find out whether you qualify for a Medicare Savings Program, use the free eligibility screener at benefitsusa.org/screener.
How to Confirm Coverage Before Your First Visit
Follow these steps before starting physical therapy to avoid surprise bills:
- Get a referral or order from your doctor. Medicare requires a physician referral for most outpatient PT. Your doctor signs a Plan of Care.
- Confirm the provider is Medicare-certified. Ask the PT clinic directly or check the Medicare provider directory at medicare.gov/care-compare.
- Request an Advance Beneficiary Notice (ABN) if coverage is uncertain. If your provider thinks Medicare may deny a service, they must give you an ABN in writing before providing it. The ABN lets you decide whether to proceed and pay out of pocket.
- Check your cumulative therapy spending if you are later in the year and have already received PT. Ask your provider or call 1-800-MEDICARE to check where you stand relative to the $2,480 threshold.
- Verify prior authorization if you have Medicare Advantage. Call the number on your plan card before your first session.
Frequently Asked Questions
Does Medicare cover physical therapy with no referral?
Medicare Part B does allow direct access to physical therapy in many cases, but most providers still require a physician referral to generate the Plan of Care needed for billing. In practice, you should get a referral from your doctor to make sure the paperwork is in order and coverage is not delayed.
How many PT sessions does Medicare cover per year?
There is no set session limit under Original Medicare in 2026. Medicare covers as many visits as are medically necessary. However, once your total therapy spending crosses $2,480, your provider must use the KX modifier to attest to medical necessity, or claims will be denied.
What is the 2026 Part B deductible for physical therapy?
The Part B deductible is $257 for 2026. You pay all costs for covered services until you reach that amount. After that, you pay 20% and Medicare pays 80% of the approved amount.
Will Medicare pay for PT after a knee or hip replacement?
Yes. PT after joint replacement surgery is a common and well-covered Medicare benefit. If you are discharged to a SNF, Part A covers your PT there. Once you move to outpatient PT, Part B takes over with the standard 80/20 split after your deductible.
Does Medicare cover physical therapy at home?
Yes, if your doctor certifies you as homebound and a Medicare-certified home health agency provides the service. There is no copay or coinsurance for approved home health PT visits.
What is the KX modifier and why does it matter to me?
The KX modifier is a billing code your PT provider adds to claims once your cumulative outpatient therapy spending exceeds $2,480 in 2026. It signals to Medicare that your continued treatment is medically necessary. If your provider fails to add it, Medicare denies the claim and you could owe the full session cost. You do not add this modifier yourself; it is your provider's responsibility.
Can I get help paying for Medicare physical therapy costs?
Yes. If your income is limited, you may qualify for a Medicare Savings Program through your state. These programs can pay your Part B deductible and the 20% coinsurance, reducing your PT costs to zero. Check your eligibility at benefitsusa.org/screener.
Does Medicare Advantage cover more PT sessions than Original Medicare?
Some Advantage plans offer additional PT benefits beyond what Original Medicare covers, but others impose stricter prior authorization requirements that can limit access. Check your specific plan's Evidence of Coverage document for the details.
