Medicare coverage for ongoing maintenance physical therapy

Article adapted with permission from Melissa Fox, PT, DPT, University of Virginia Health System.

There are times when a short course of physical therapy (PT) can meet your current needs, and you can then continue exercises on your own. Other times, however, ongoing PT may be necessary to maintain your current status (strength, flexibility, mobility, etc.) and to prevent further deterioration of your condition.

A common misconception is that Medicare will only cover PT when a patient is improving (getting stronger, moving more independently, gaining flexibility). Often physical therapists discharge patients [with chronic, degenerative conditions] because they do not realize that ongoing skilled maintenance therapy is covered by Medicare.

Actually, Medicare can cover ongoing PT if you therapist feels that such therapy is needed to maintain your current function and slow your decline. If that is the case, instead of discharging you from PT, there are two options:

  1. The therapist can give you a home program, but continue to periodically re-evaluate you, address new needs, and modify your home program, or
  2. The therapist can personally provide ongoing skilled maintenance therapy due to safety and/or complexity of your situation.

In both cases, the therapist will need to document justification for ongoing PT, in order for Medicare to cover it. I have created a handout that you can provide to your PT, which details coverage, documentation, Medicare resources, American Physical Therapy Association resources, etc.

Download the Guidelines for Physical Therapists Treating Clients with Neuromuscular Disorders.

Your physical therapist is the one who should decide if you would benefit from ongoing maintenance physical therapy. The information provided above is general in nature, not specific to your situation. Your personal physical therapist may decide that you would not benefit from ongoing services, or that they cannot provide this.

Visit the Center for Medicare Advocacy for self-help packets for clients who have experienced therapy denials.


6 responses to “Medicare coverage for ongoing maintenance physical therapy”

  1. Thank you, June, for this very timely article. The evaluator at my clinic tried to tell me that Medicare would stop paying for my sessions at some point soon. Now I have some ammo to fight him with!

  2. Thank you for this timely article. I am transitioning to Medicare in 30 days. This is news I need.

    Margaret Mueller
    Roseville, CA

  3. Thank you for this information. I am just in the process of trying to figure out how to get ongoing pt and I did not know this. Always thought the doctor had to approve it for Medicare to pay. I will take this information to my therapist. Thank you so much

  4. I am interested in finding a doctor in Charlotte NC. I thought your site would be a good resource but not finding any information. I have been living with FSH for 30 yrs with little affect but am starting to feel aches and pains and seeing body changes…. Thinking I would like to have a doctor who understands my disease. I would like to have private doctor rather than relying on the clinic.

    • Hi Susan, we don’t know of a specific doctor in Charlotte (apart from the MDA clinic), but one patient has recommended a physical therapist: Scott Holsten PT, Carolina Neurosurgery and Spine, 1010 Edgehill Rd, N Charlotte, NC. If you are willing to travel, we recommend Edward Smith MD, Division of Pediatric Neurology, Duke Children’s Hospital & Health Center, Durham NC. Appointments 919-668-4000. Dr. Smith sees adult and pediatric patients, even if he’s at the Children’s Hospital. Good luck!

Leave a Reply

Your email address will not be published. Required fields are marked *