Medicare Coverage for Outpatient Physical Therapy Limits

Medicare does not have a hard annual cap on medically necessary outpatient physical therapy. Original Medicare can continue covering therapy after you pass its annual therapy threshold if your provider documents that the care remains reasonable and necessary. In 2026, you generally pay the Part B deductible first, then 20% of the Medicare-approved amount for covered outpatient therapy.

Physical therapy is usually covered through medicare part b coverage when it is furnished by a Medicare-enrolled provider and meets Medicare’s medical-necessity rules. Medicare Advantage plans must cover at least what Original Medicare covers, but their network, referral, and prior-authorization rules can differ.

What the Medicare therapy limits actually mean

The annual dollar amounts are tracking thresholds, not coverage caps. The Centers for Medicare & Medicaid Services, or CMS, is the federal agency that administers Medicare. CMS uses the thresholds to identify therapy claims that may need closer review, rather than ending benefits automatically.

According to the CMS Medicare Physician Fee Schedule, the 2026 therapy threshold is $2,480 for physical therapy and speech-language pathology combined, while occupational therapy has its own separate $2,480 threshold. The $3,000 medical-review threshold applies separately to the physical therapy and speech-language pathology group and to occupational therapy.

What Medicare Part B covers for physical therapy

Part B may cover outpatient physical therapy in places such as a therapist’s office, an outpatient hospital department, a rehabilitation agency, a skilled nursing facility when you are not receiving Part A-covered care, or at home in certain outpatient situations. The service must be ordered or certified when required, provided by a qualified professional, and documented as medically necessary.

Medicare coverage is based on your condition and treatment goals, not on whether you have used a certain number of visits. Medicare may cover therapy to improve function, maintain function, or slow further decline when skilled therapy is needed. The official Medicare.gov physical therapy coverage page explains that Part B covers medically necessary outpatient physical therapy.

What you may pay for outpatient physical therapy

With Original Medicare, you generally pay the annual Part B deductible and then 20% of the Medicare-approved amount for covered services. Your actual cost can be lower if you have a Medigap policy or other secondary coverage. If you have Medicare Advantage, your plan may use a copayment, coinsurance, network rules, or visit-management procedures instead.

Before starting a longer course of care, ask the therapy office whether it accepts Medicare assignment and whether it can estimate your out-of-pocket cost. If you are comparing plan rules, this guide to medicare prior authorization can help you understand when a plan may require approval before certain services.

How to avoid surprises when therapy continues

Ask your therapist early whether your physical therapy and any speech-language pathology services are approaching the annual threshold. Keep your Medicare Summary Notice and provider bills, because they show what Medicare was billed and paid. If Medicare denies a claim, you have appeal rights and can review the reason on your notice.

If you have both Medicare and Medicaid, your cost sharing and care options may work differently. Read about medicare and medicaid dual eligible coverage before assuming you will owe the standard Part B amount. You can also review how benefits interact in our guide to medicare and social security.

When to check your plan instead of relying on general rules

Original Medicare rules are a useful baseline, but Medicare Advantage plans can set their own administrative rules within Medicare requirements. Check your plan’s Evidence of Coverage or contact the plan before beginning therapy, changing providers, or continuing a long treatment plan. For related outpatient benefits, see our guide to medicare coverage for mental health services.

The most useful next step is to confirm your type of Medicare coverage, your provider’s network status, and how your plan handles continued therapy. That gives you a clearer picture than the threshold number alone.