Original Medicare (Parts A & B): Physical, Occupational, and Speech Therapy

Sometimes illness and injury occur that cause functional decline and require us to rebuild our skills and strength. PT, OT, and ST are expert allies.

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Cost
20% of the Medicare-approved amount; Part B deductible applies
Prior Authorization Required
No
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  1. The provider must certify that therapy (PT, OT, or ST) is medically necessary.

    • PT means Physical Therapy

    • OT means Occupational Therapy

    • ST means Speech Therapy

  2. The provider makes a referral for evaluation and treatment.

  3. Locate a Medicare-certified home health agency (Find home health services near me) or an outpatient services facility from which to receive therapy.

    • Note that for home health services, a provider must certify that your loved one meets home health criteria.

  4. Schedule an appointment for an initial evaluation, care plan development, and scheduling of future visits.

  5. Attend the visits as scheduled until care plan goals are met, or progress toward goals ceases.

  6. Follow through with any instructions, home exercises, and recommendations.

For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.

Availability
As ordered by a provider and ongoing till goals are met

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Physical therapy (PT)

Physical therapy (PT) focuses on the acquisition and/or improvement of skills related to gross motor movement (sitting, standing, walking, lifting), strength, and balance.

When your loved one's provider certifies that it is needed, Medicare covers evaluation and treatment for injuries and diseases that change your loved one's ability to function, or improve or maintain current function, or slow decline.

Occupational therapy (OT)

Occupational therapy (OT) focuses on the acquisition and mastery of basic, self-help skills required for daily living.

When your loved one's provider certifies that it is needed, Medicare covers medically necessary therapy to help your loved one perform activities of daily living (ADLs), like dressing or bathing. This therapy helps to improve or maintain current capabilities or slow decline.

Speech-language pathology/therapy (SLP, ST, or SLT)

Speech therapy (ST) focuses on the acquisition and use of language through mechanics of speaking, strength of voice, cognitive processing, and social rules of verbal and visual language. It also focuses on safe swallowing.

When your loved one's provider certifies that it is needed, Medicare covers medically necessary evaluation and treatment to regain and strengthen speech and language skills or to improve or maintain current function, or slow decline. This includes cognitive and swallowing skills.

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