Medicare Part B Coverage for
Physical & Occupational Therapy

At Healthy At Home Physical Therapy, we provide care that follows Medicare guidelines for medical necessity and skilled therapy.

Medicare Part B may cover physical and occupational therapy when treatment is medically necessary and requires the skills of a qualified therapist. Coverage may include therapy to improve function as well as skilled therapy needed to maintain function or prevent or slow decline.

Restorative vs. Maintenance Therapy

Restorative Therapy — Helping You Improve

Restorative therapy is appropriate when skilled treatment is expected to help you improve or regain function following an injury, illness, surgery, hospitalization, or other change in your condition.

This may include:

A measurable decline in walking, balance, strength, transfers, or daily activities.
Recovery following a fall, fracture, surgery, illness, or hospitalization.
A new functional limitation that is expected to improve with skilled therapy.

Example: You were previously walking independently but now require a walker following a hospitalization. Skilled therapy may help you regain strength, balance, mobility, and independence.

Maintenance Therapy — Helping You Maintain Function

Medicare does not require you to improve in order for skilled therapy to be covered.

Maintenance therapy may be covered when the skills of a therapist are necessary to maintain your current function or prevent or slow deterioration.

A therapist may be needed to establish or modify a maintenance program, periodically reassess your condition, train you or your caregiver, or provide ongoing treatment when your condition requires skilled intervention.

This can be particularly important for people with chronic or progressive conditions such as Parkinson's disease, Multiple Sclerosis, or other neurological conditions.

Example: A person with Parkinson's disease may require skilled therapy to address changes in walking, balance, posture, or transfers and to modify treatment as their needs change.

Maintenance therapy is based on your individual skilled needs—not simply your diagnosis or whether you are improving.

Skilled vs. Non-Skilled Therapy

For Medicare to cover therapy, treatment must require the skills, knowledge, and clinical judgment of a qualified therapist.

A service isn't automatically considered skilled simply because a PT or OT performs it.

Skilled Therapy May Include:

Specialized assessment and treatment of functional impairments.
Gait and mobility training requiring skilled cueing or modification.
Neuromuscular re-education for balance, coordination, or neurological conditions.
Therapeutic exercise requiring skilled progression or modification.
Fall-risk assessment and individualized fall-prevention strategies.
Training in adaptive equipment or techniques.
Caregiver education requiring skilled instruction.
Development or modification of a home or maintenance program.
Reassessment and modification of treatment as your condition changes.

Services That May Not Require Skilled Therapy:

General exercise, stretching, or fitness activities.
Routine strengthening or endurance exercises.
Supervision of an established exercise program.
Routine walking or transfer assistance.
Exercises that can safely be performed independently or with a caregiver.
Repetitive treatment that no longer requires clinical judgment or modification.
General conditioning or wellness activities.

It is important to note that you may still benefit greatly from exercise or continued support even when it no longer requires the skills of a therapist. Beneficial care and skilled care are not the same thing according to Medicare.

What Happens When Medicare-Covered Therapy Ends?

We do not discontinue Medicare-covered therapy simply because you've received a certain number of visits, have been in therapy for a certain amount of time, or are no longer making rapid progress. Instead, your therapist continually asks:

Do you still require the skills of a therapist to safely and effectively address your condition?

When the answer is yes, continued skilled therapy—including maintenance therapy when appropriate—may continue to meet Medicare's coverage requirements. When the answer is no, it may be time to transition to another level of support. It's also important to understand that a new doctor's referral does not automatically restart Medicare-covered therapy. If you return to us with a new referral, your therapist will evaluate whether you have a new or ongoing skilled need that meets Medicare's coverage requirements.

Continuing Your Progress After Skilled Therapy

Discharge from Medicare-covered therapy doesn't mean you have to stop working toward your goals.

Healthy At Home offers several private-pay options to help you continue working on strength, balance, mobility, fitness, and independence when Medicare-covered skilled therapy is no longer appropriate.

PT & OT Wellness Visits

If you would like to continue working with a licensed physical or occupational therapist, our private-pay Wellness Program may be an appropriate next step. Wellness visits can focus on exercise, strength, balance, mobility, maintaining progress made during therapy, and supporting long-term independence.

Personal Training

For individuals who no longer require the expertise of a PT or OT but would benefit from continued one-on-one exercise, supervision, and accountability, we also offer the option to transition to a personal trainer.

Personal training can provide an affordable and sustainable way to continue an established exercise program and work toward long-term strength, balance, fitness, and wellness goals.

Supplemental Wellness Services

Private-pay wellness or personal training may also be appropriate if you're receiving insurance-covered rehabilitation through another provider but would like additional noncovered exercise, fitness, or wellness support. These services are intended to supplement—not duplicate—medically necessary skilled therapy provided through insurance. If you are currently receiving Medicare home health or VNA services, please let us know. Special Medicare billing rules may apply, and we will review your individual situation before beginning supplemental services.

Our Goal: A Transition, Not an Endpoint

Our goal is to help you receive the right level of care at the right time.

That may mean restorative therapy, skilled maintenance therapy, an independent or caregiver-assisted exercise program, private-pay PT, OT wellness visits, or personal training. Ending Medicare-covered skilled therapy doesn't mean you have to stop working toward your goals. We'll help you determine the safest and most appropriate next step.

Medicare coverage is determined on an individual basis. This information provides a general explanation of Medicare therapy coverage and does not guarantee coverage or payment for any particular service.

Medicare Part B Coverage for Physical & Occupational Therapy