Physical therapy is one of the best-evidenced treatments for chronic pain — and one of Medicare’s most reliable benefits. Here is what is covered, what you pay, and what changed about the old "therapy cap."
What Medicare covers
Medicare Part B covers outpatient physical therapy (and occupational therapy) when it is medically necessary and provided under a plan of care your therapist establishes and your clinician reviews. That includes therapy aimed at chronic pain: strengthening, graded activity, manual therapy, and education.
The "therapy cap" is gone
Congress removed the hard annual cap on therapy in 2018. Today there is an annual threshold amount instead: once your therapy charges pass it, your therapist adds a documentation flag confirming continued medical necessity — care continues as long as it is medically justified. For chronic pain, that matters: you are not automatically cut off after a set number of visits.
What you pay
After the Part B deductible, you pay 20% of the Medicare-approved amount; Medicare pays 80%. Medigap policies typically cover the 20%. Medicare Advantage plans must cover the same services but may require prior authorization or use specific therapy networks — check before starting.
Getting the most from PT for chronic pain
- Ask for a therapist experienced with persistent pain (graded exposure, pacing), not just post-surgical rehab.
- Agree on functional goals — walking distance, sleep, stairs — not just pain scores.
- Ask for a home program early; most progress happens between visits.
- If progress stalls, ask about adding behavioral therapy or a physiatrist evaluation rather than simply stopping.
Frequently asked questions
How many PT sessions does Medicare allow per year?
There is no fixed limit. Since 2018 Medicare has no hard therapy cap — after an annual threshold amount, your therapist documents that continued therapy is medically necessary and covered care continues.
What does physical therapy cost with Medicare?
After the Part B deductible you pay 20% of the Medicare-approved amount per visit; Medicare pays 80%. Medigap plans usually pick up the 20%.
Do I need a referral for PT under Medicare?
You can generally start evaluation directly, but Medicare requires your plan of care to be certified by a physician or qualifying practitioner, and Medicare Advantage plans may require referrals or prior authorization.