2024 Medicare Coverage Update- How Many Physical Therapy Sessions Are Covered-
How Many Physical Therapy Sessions Does Medicare Cover in 2024?
As the healthcare industry continues to evolve, understanding the coverage provided by insurance companies like Medicare becomes increasingly important. One common question among patients is, “How many physical therapy sessions does Medicare cover in 2024?” This article aims to provide a comprehensive overview of Medicare’s coverage for physical therapy in the upcoming year.
Medicare, the federal health insurance program for individuals aged 65 and older, as well as certain younger individuals with disabilities, offers coverage for a variety of medical services, including physical therapy. In 2024, Medicare’s coverage for physical therapy sessions is subject to certain limitations and criteria.
Firstly, it is essential to note that Medicare covers physical therapy services only when deemed medically necessary by a physician. This means that the patient must have a documented condition that requires physical therapy to improve their function or relieve pain. Once the physician has determined that physical therapy is necessary, the patient can begin receiving covered sessions.
For 2024, Medicare will cover up to 80 physical therapy sessions per benefit period. A benefit period for Medicare is defined as a 12-month period, starting from the first day of the month in which the patient receives their first covered physical therapy session. It is important to note that the 80-session limit is cumulative, meaning that the patient can use up to 80 sessions across different types of physical therapy, such as outpatient therapy, home health therapy, or inpatient therapy.
However, there are certain criteria that must be met for each session to be covered by Medicare. The patient must have a face-to-face encounter with a physician or qualified non-physician practitioner (NP) within the past six months to establish the medical necessity of the physical therapy. Additionally, the patient must have a plan of care developed by a physical therapist, which outlines the goals, frequency, and duration of the therapy sessions.
It is also worth mentioning that Medicare has implemented a coinsurance requirement for physical therapy sessions. For outpatient therapy, the patient is responsible for a 20% coinsurance after the deductible has been met. The deductible for 2024 is $226. For inpatient therapy, the coinsurance is 20% of the cost of care, with a daily copayment of $176 for the first 20 days of care.
In conclusion, for 2024, Medicare will cover up to 80 physical therapy sessions per benefit period, provided that the sessions are deemed medically necessary and meet certain criteria. Understanding these limitations and requirements can help patients make informed decisions about their healthcare and ensure that they receive the necessary care to improve their quality of life.
