Does Medicare Advantage cover Physical Therapy?

Yes. Medicare Advantage plans must cover the same medically necessary services as Original Medicare. Cost sharing differs — usually a flat copay instead of 20% coinsurance. Medicare Advantage plans may require prior authorization even when Original Medicare does not.

What is the Medicare Part B deductible in 2026?

The 2026 Part B deductible is $257. You pay this amount once per year before Medicare starts covering its 80% share. A Medigap supplement policy (Plan G, Plan N, etc.) can cover this deductible for you.

Does Medigap (Medicare supplement) cover my coinsurance?

Yes. Most Medigap plans (Plan G, Plan F, Plan N) cover the 20% coinsurance you owe after Original Medicare pays its 80% share. Plan G is the most comprehensive supplement currently available to new Medicare enrollees.

Rehabilitation

John Caruso, FSA, MAAA • June 26, 2026 • 7 min read

Medicare Part B covers Physical Therapy at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.

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Does Medicare Cover Physical Therapy? (2026)

Q: Does Medicare cover Physical Therapy?

Yes. Medicare Part B covers medically necessary physical therapy. You pay 20% coinsurance after the $257 Part B deductible (2026). Original Medicare has no annual out-of-pocket cap — Medigap supplements fill this gap.

Yes. Medicare Part B covers medically necessary physical therapy when it is restorative (improving function, not merely maintaining it), ordered by a Medicare-enrolled physician, and performed according to a plan of care. There is no longer an annual dollar cap, but the KX modifier system creates ongoing documentation requirements.

Quick answer:

Medically necessary, restorative PT: Part B — 80% after $257 deductible
Your share: 20% coinsurance (no cap under Original Medicare)
Annual dollar cap: Removed permanently (Budget Act 2018)
KX modifier threshold (2026): $2,410 for PT + speech combined — triggers attestation requirement
Maintenance therapy: Generally not covered under Medicare

What Medicare Part B Covers for PT

Medicare Part B covers:

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Initial PT evaluation (CPT 97161/97162/97163)
Individual therapeutic procedures (CPT 97110, 97140, 97530, etc.)
Therapeutic activities and neuromuscular re-education
Group therapy (at a lower rate)
Services by a physical therapist, PT assistant, or therapist incident-to in a physician's office

The restorative requirement: Medicare requires that PT improve your condition to its highest practicable function. Once you've reached your highest achievable level, therapy is "maintenance" — and Medicare generally does not cover maintenance therapy.

The KX Modifier: What It Means for Your Care

Once your cumulative Part B therapy costs (PT + speech therapy combined) exceed $2,410 in 2026, your therapist must attach the KX modifier to every claim. The KX modifier is an attestation by your therapist that:

Your care is medically necessary
Continued therapy is expected to improve your condition
The services are reasonable and necessary for your condition

Without the KX modifier above the threshold, Medicare can deny the claims. Your therapist manages this — but you should know about it so you're not surprised if your physical therapist asks to review your plan of care and progress notes.

Medicare Advantage PT Coverage

Medicare Advantage plans must cover the same medically necessary PT as Original Medicare. Many MA plans:

Apply a per-visit copay instead of 20% coinsurance
May have visit caps or require prior authorization for extended PT courses
Some plans offer enhanced PT benefits beyond the Original Medicare standard

Related Cost Information

Medical bills contain errors in roughly 80% of cases. Most go uncontested.

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About the Author

John Caruso, FSA, MAAA

Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.

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Does Medicare Cover Physical Therapy? (2026)

What Medicare Part B Covers for PT

Medical bills contain errors in roughly 80% of cases. Most go uncontested.

The KX Modifier: What It Means for Your Care

Medicare Advantage PT Coverage

Related Cost Information

Medical bills contain errors in roughly 80% of cases. Most go uncontested.

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About the Author

Estimate Your Physical Therapy Medicare Cost