Does Medicare Cover Physical Therapy?

Short answer: yes, and there's no cap. Medicare Part B covers medically necessary outpatient physical therapy, occupational therapy, and speech-language pathology. There's no limit on how much Medicare pays for medically necessary outpatient therapy in a calendar year. You pay 20% of the Medicare-approved amount after you meet the Part B deductible.

Is there a Medicare cap on physical therapy? Quick answers

• Is there a hard dollar cap? No. Congress ended the hard annual cap on outpatient therapy in 2018.
• Is there any number I should know? Yes. For 2026, a "KX modifier" threshold of $2,480 applies. Above it, your therapist must confirm the care is still needed. It is not a stopping point.
• Is there a limit on visits? No. As long as the care is medically necessary, there is no limit on visits or on the total amount Medicare pays.
• What will I pay? You pay 20% of the Medicare-approved amount after you meet the Part B deductible.
• What if I have a Medicare Advantage plan? The plan must cover what Original Medicare covers. It may add its own rules, such as approval first or a network of therapists.

The rest of this page explains each point, so you can see why the old "cap" no longer ends your care.

The "Therapy Cap" Myth

Medicare used to have a hard annual dollar cap on outpatient therapy. Congress repealed it. Section 50202 of the Bipartisan Budget Act of 2018 ended the therapy caps and their exceptions process. You may still hear about a "therapy cap" in older articles or from people who had therapy years ago. The term stuck around even though the hard cutoff didn't survive.

What Replaced the Cap: The KX Modifier Threshold

In place of the old hard cap, the law kept the former cap amounts as a paperwork threshold. Your combined billed amount for physical therapy and speech-language pathology may pass that threshold in a calendar year. Then your therapist adds a "KX modifier" to your claim. It confirms that more therapy is still medically necessary. For calendar year 2026, that KX modifier threshold is $2,480 for physical therapy and speech-language pathology combined. There is a separate $2,480 for occupational therapy.

There's a second, higher threshold used for targeted medical review. For 2026, that threshold is $3,000 for physical therapy and speech-language pathology services combined. Crossing it doesn't mean your claim will automatically be reviewed. It only means claims above that level can be picked for targeted review, and not every claim gets pulled.

For you as a patient, neither threshold changes what you pay or whether Medicare keeps covering your care. They're billing and paperwork rules for your provider. They are not a stopping point for your treatment.

What You Pay

Outpatient physical therapy is covered under Medicare Part B. Before Medicare pays its share, you pay the annual Part B deductible — $283 for 2026. After that, you pay 20% of the Medicare-approved amount for each covered therapy visit. There is no upper limit on the number of visits or the total amount, as long as the care stays medically necessary.

A doctor or other qualified provider must certify that the therapy is medically necessary. The plan of care must be reviewed from time to time. Say you're in a Medicare Advantage plan instead of Original Medicare. Your plan must cover at least what Original Medicare covers. But it may require prior authorization or use of network therapy providers. See how prior authorization works before you start a course of therapy.

Where Else Therapy Shows Up

Physical therapy isn't only an outpatient Part B service. You may be recovering after a hospital stay. Then therapy may be part of care in a skilled nursing facility under Part A. It may also be part of a home health episode if you're homebound and qualify. Those settings have their own rules and cost-sharing. This page covers outpatient therapy billed under Part B. That is what most people mean when they ask "does Medicare cover physical therapy."

Common Questions