Can physical therapists bill Medicare?
Asked by: Grady Lakin | Last update: July 25, 2025Score: 4.7/5 (56 votes)
Are physical therapists covered by Medicare?
Yes. Medicare Parts A and B cover physical therapy considered medically necessary to treat an injury or illness, including managing a chronic condition like Parkinson's disease or aiding recovery from a fall, stroke or surgery.
Can a therapist bill Medicare?
Effective January 1, 2024, MFTs and MHCs can bill Medicare independently for their services furnished for the diagnosis and treatment of mental illnesses. Medicare Part B pays MFTs and MHCs for these services at 75% of what a clinical psychologist is paid under the Medicare Physician Fee Schedule.
What is the billing rule for PT?
The 8-minute rule stipulates that at least 8 minutes of a single intervention must be administered in order to bill for one CPT unit. While one might think that one can then bill for two units after 16 minutes of treatment have been completed, that would be too simple.
What is the rule of 8 for Medicare physical therapy?
Per Medicare rules, to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes. Medicare adds up the total minutes of skilled, one-on-one therapy and divides the sum by 15. If eight or more minutes are left over, you can bill for an additional unit.
Can Physical Therapists Bill Medicare Directly
How many PT sessions allowed by Medicare?
How many visits of physical therapy am I allowed per year? There is not a set number of visits that you are allowed by Medicare per year. Instead, it's determined by medical necessity.
Who can bill for physical therapy services?
Therapy services must be provided by a qualified clinician i.e., physician, non-physician practitioner (NPP), therapist, or speech-language pathologist (SLP). Treatment services may also be provided by an appropriately supervised physical therapy (PT) or occupational therapy (OT) assistant.
Does Medicare require a script for PT?
Medicare is divided into several parts, each with its own referral rules: Original Medicare (Parts A and B) typically does not require referrals for beneficiaries to access specialist services, including physical therapy. However, therapists must ensure they are enrolled in Medicare for their services to be covered.
What is the Medicare one on one rule for physical therapy?
For time-based codes, you must provide direct treatment for at least eight minutes in order to receive reimbursement from Medicare. Basically, when calculating the number of billable units for a particular date of service, Medicare adds up the total minutes of skilled, one-on-one therapy and divides that total by 15.
Is PT covered by insurance?
The short answer is generally yes. Most health insurance plans, like Medicare, offer some physical therapy insurance coverage. However, the scope of your coverage varies significantly from one plan to another.
Why don t therapists take Medicare?
Many therapists don't accept Medicare—or other kinds of insurance—because of low reimbursement rates and the amount of unpaid time they have to spend on complicated paperwork to file a claim.
Can a doctor refuse to bill Medicare?
Doctors or other health care providers who don't want to work with the Medicare program may "opt out" of Medicare. Medicare won't pay for items or services you get from provider that opts out, except in emergencies. Providers opt out for a minimum of 2 years.
Does Medicare cover therapy sessions?
The short answer is yes. Medicare offers coverage for therapy and a variety of other mental health services. Depending on which part you use, some benefits of Medicare coverage include counseling or therapy, in-patient care, outpatient care, medication management, and certain preventive services.
Why won't Medicare pay for physical therapy?
Authorization by Licensed Physician
Medicare will not pay for physical therapy services unless the claim and documentation prove that a licensed physician has authorized the plan of care.
What is the 10 visit rule for Medicare?
At minimum, a licensed therapist must complete a progress note—a.k.a. progress report—for every patient by his or her tenth visit. In it, the therapist must: Include an evaluation of the patient's progress toward current goals. Make a professional judgment about continued care.
How many physical therapy sessions does insurance cover?
Insurance typically won't pay for physical therapy that you seek out yourself. Most insurance plans put a cap on how many physical therapy visits will be covered. A typical plan could only cover 30 physical therapy visits per year. After that, you'd have to pay the full cost yourself.
Does Medicare pay 100% of physical therapy?
Medicare Part B covers physical therapy in a doctor's or therapist's office, or at home if you are unable to travel. Part B will pay 80% of the Medicare-approved amount after you pay your Part B deductible ($240 in 2024).
What is the 8-minute rule in physical therapy?
The 8-minute rule was introduced into the rehab therapy billing process in the year 2000 and is utilized by outpatient physical therapy services, allowing a physical therapy practitioner to bill for services as long as they see their patient for at least eight minutes, which would serve as one unit of therapeutic ...
How many PT sessions do you get with Medicare?
There's no limit on how much Medicare pays for your medically necessary outpatient physical therapy services in one calendar year.
How much does Medicare pay for a PT visit?
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.
Can I see a specialist without a referral on Medicare?
Original Medicare benefits through Part A, hospital insurance and Part B, medical insurance, do not need their primary care physician to provide a referral in order to see a specialist. Complications with coverage can occur if you see a specialist who is not Medicare-approved or opts out of accepting Medicare payments.
What is the 15 minute rule for physical therapy?
That's where the 8-Minute Rule comes in: Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes. In other words, Medicare adds up the total minutes of skilled, one-on-one therapy (direct time) and divides the resulting sum by 15.
Does Medicare require a referral for physical therapy?
Yes, Medicare patients may come to physical therapy Direct Access. Once the physical therapy evaluation is complete, it will be sent to your physician. Medicare does not require a physician order but does require the physician signature on the physical therapy plan.
What is the Medicare cap for physical therapy 2024?
These per-beneficiary amounts under section 1833(g) of the Act (as amended by 1997 BBA) are updated each year by the Medicare Economic Index (MEI). For Calendar Year (CY) 2024, the KX modifier threshold amounts are: (a) $2,330 for PT and SLP services combined, and (b) $2,330 for OT services.