Does Medicare cover it?
Does Medicare cover physical therapy?
Yes. Part B pays for medically necessary outpatient physical therapy once a provider certifies you need it, and there is no yearly limit on what Medicare pays. The estimator prices a course of sessions for your area at 2026 rates.
What this service costs you
You pay
$432
| Medicare-approved amount | $1,030 |
| Part B deductible used | $283 |
| Your 20% or copayment | $149 |
| Medicare pays | $598 |
| Deductible left after this | $0 |
Part B: you pay the yearly deductible ($283 in 2026), then 20% of the approved amount.
Same service at national rates: $436
How this is calculatedMedicare Part B covers outpatient physical therapy that is medically necessary, after your doctor, a nurse practitioner, a clinical nurse specialist or a physician assistant certifies that you need it, and it sets no limit on how much it pays for that therapy in a calendar year. You pay 20% of the Medicare-approved amount once the $283 Part B deductible is met. At national 2026 rates, the first evaluation of moderate complexity is approved $98, so your share is $20, and a typical session of three 15-minute units of exercise is approved $87, leaving you $17. A course of twelve sessions therefore costs you about $209 on top of the evaluation. The number people often confuse with a cap is the KX threshold: $2,480 in 2026 for physical therapy and speech-language pathology combined. Once billed therapy passes it, Medicare keeps paying, but the therapist must add a modifier confirming that the care is still medically necessary and document why. Medigap Plan G pays the 20% in full after the deductible; prices also vary with the local cost area of the clinic.
Therapy visits and the KX threshold
Billed toward the threshold
$2,190
| 2026 KX threshold (PT + speech) | $2,480 |
| Sessions before it is reached | 27 |
| Your 20% (deductible met) | $438 |
Above the threshold Medicare keeps paying when the therapist documents medical need: it is not a cap.
Costs computed by Radif Partners · Editorial policy · How the costs are calculated
What Part B pays for
Physical therapy, in Medicare's words, helps restore or improve movement after an injury, an illness or surgery, and can also help maintain your current function or slow a decline. That last part matters: therapy does not have to promise a full recovery to be covered. What it needs is a provider's certification that it is medically necessary, and an outpatient setting such as a therapist's office or clinic.
Evaluation first, then sessions
A course of therapy starts with an evaluation, billed once, and continues with sessions made of timed units of exercise and hands-on work. The table prices the most common pattern at national 2026 rates: an evaluation of moderate complexity, then sessions of three 15-minute units.
| Item | Medicare-approved amount | Your 20% |
|---|---|---|
| Evaluation, moderate complexity | $98 | $20 |
| One session, three 15-minute units | $87 | $17 |
| Twelve sessions | $1,046 | $209 |
If therapy is the first Part B care of your year, the deductible is paid out of the first claims. The evaluation then costs you $98, and the twelve sessions that follow $357, because what remains of the deductible is taken from them before the 20% applies.
The KX threshold, explained without the jargon
The dollar figure attached to outpatient therapy, $2,480 in 2026 for physical therapy and speech-language pathology together, works as a checkpoint. When the year's approved amounts reach it, the therapist must mark each further claim with the KX modifier, a statement that the therapy is still medically necessary, and keep notes that back it up. Occupational therapy has its own threshold of $2,480.
For you, nothing changes in price above the threshold: the session is still approved at the same amount and you still pay 20%. What matters is the therapist's documentation, so a long course of therapy, after a joint replacement for example, is worth discussing with the clinic before the threshold is reached. The mini tool shows how many sessions fit under it.
Your 20% of a Part B bill
You pay
$100
| Approved amount | $500 |
| Deductible | $0 |
| 20% coinsurance | $100 |
| Limiting charge above it | $0 |
Clinic location and supplemental coverage
The fee for each unit is adjusted to the local cost of running a practice. Twelve sessions with the deductible met cost you $234 in Manhattan and $196 in Alabama, against $209 at national rates. Choose your state and price area in the estimator to see the figure for your clinic.
A Medigap policy changes the share far more than location does. Plan G pays all of the 20%, which brings the twelve sessions to $0 once the deductible is met. Plan K pays half, leaving $105. With a Medicare Advantage plan, the plan sets its own cost sharing, at least as broad in coverage as Original Medicare; enter your plan's figures in the estimator.
Therapy at home is a separate benefit
If you are homebound and receive physical therapy from a Medicare-certified home health agency, the visits fall under the home health benefit, and you pay nothing for them. The 20% described on this page applies to outpatient therapy, the kind you travel to.