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Therapy Coverage

We've had many questions in regards to therapy, coverages for therapy, and gaps in this coverage. Let's clarify the cloud surrounding Medicare's coverage of outpatient therapy, physical therapy, speech-language therapy, and occupational therapy,

Prior to 2018, Medicare had a therapy cap of $2,010 for physical and speech-language therapy and $2,010 for occupational therapy. This was a hard cap, with no option of additional coverage. In early 2018, the cap was removed. With the repeal, Medicare Part B will cover up to $2,110 for physical, speech/language, and occupational therapy before requiring that your provider confirms that therapy is medically necessary. Medicare law now no longer limits how much it pays for medically necessary outpatient therapy services in one calendar year.

If you have a Medicare Supplement, your supplement will provide coverage for the remainder (20%) as long as you have met your Part B deductible for the year ($203 in 2021). If you have a Medicare Advantage Plan, you will typically have a copay for therapy services. In Harris and Fort Bend county, this copay averages $40/visit at in-network providers.

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