Why Does Medicare Pay for Some Physical Therapy with Part A and Others with Part B?

In a previous article, we discussed physical therapy at length. Instead, this article aims to answer the question: Why is it that Medicare will pay for some physical therapy with Part A and others with Part B? 

First, let’s get a fresh look at what each part covers:

Medicare Part A

This is known as Hospital Insurance and it covers things like inpatient hospital care, skilled nursing facility care, nursing home care, hospice care, and home health services (including physical and occupational therapy). Put together with Medicare Part B, it makes up what is known as Original Medicare.

Medicare Part B

This makes up a person’s medical insurance, and it covers those services deemed medically necessary as well as any supplies needed to diagnose or treat your health condition. It includes outpatient services given at a hospital, doctor’s office, clinic or other type of health facility. Part B also covers a lot of preventative services to prevent illness or detect them at an early stage.

Services and supplies that are covered by Medicare Part B include (but might not be limited to) the following:

  • Doctor’s visits
  • Laboratory tests and X-rays
  • Emergency ambulance services
  • Mental health services
  • Durable medical equipment
  • Preventative services like pap tests, flu shots, and screenings
  • Rehabilitative services such as physical therapy, occupational therapy, and speech-language pathology.

You may have noticed that physical therapy is covered by both Medicare Parts A and B, but why is that? The simple answer is that there are “therapy caps.” This means that there is a dollar maximum that each part will cover, so both are needed in case one does not entirely cover the cost of the therapy.