How Much Does Medicare Pay For Physical Therapy 2018?

As one navigates the intricacies of America's healthcare system, understanding Medicare coverages and costs is a vital component of ensuring adequate healthcare. One area often overlooked is that of physical therapy, specifically, pelvic floor therapy. Estimates say 1 in 4 women experience pelvic floor issues, making it essential to understand the financial implications of this treatment. In this guide, we will dive into the coverage Medicare provides for physical therapy in 2018, and how these costs can affect an individual seeking pelvic floor therapy.

First, let's start with a brief explanation of Medicare. Medicare is a federal health insurance program designed for people aged 65 and over, certain younger individuals with disabilities, and those with end-stage renal disease. The program is divided into four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). For the purpose of discussing physical therapy and pelvic floor therapy coverages, we will focus on Medicare Part B.

Medicare Part B: Physical Therapy Coverage

Medicare Part B covers medically necessary outpatient physical therapy services, including pelvic floor therapy. These therapy services can be provided by any qualified outpatient therapy provider, including at a Comprehensive Outpatient Rehabilitation Facility (CORF), a Rehabilitation Agency (OPRA), a Skilled Nursing Facility (SNF), or at a therapist's office.

In order to determine coverage for these physical therapy services, Medicare processes therapy services under the Outpatient Therapy Caps, which set a limit on the total amount of therapy services a beneficiary can receive in a calendar year. In 2018, the Medicare Part B therapy cap amounts were:

• $2,010 for physical therapy (PT) and speech-language pathology (SLP) services combined
• $2,010 for occupational therapy (OT) services

How Much Does Medicare Pay For Physical Therapy 2018? Example

Let's look at a realistic example of how Medicare can help cover the costs for a woman who needs pelvic floor therapy. Suppose Jane, a 65-year-old woman, is suffering from pelvic floor dysfunction and is referred by her physician to undergo pelvic floor therapy. Jane has Medicare coverage, primarily Medicare Part B.

Under the 2018 therapy cap limits, Jane will have up to $2,010 worth of coverage for her physical therapy and any necessary speech-language pathology services. This means that Jane can receive her pelvic floor therapy services until she reaches this cap.

However, if Jane requires more therapy than the cap limit, she may still be able to receive coverage for her medically necessary services. The Medicare Part B KX modifier can be used by her therapy provider to assert that the therapy is medically necessary, allowing Jane to continue receiving coverage for her therapy services.

Understanding the specifics of Medicare coverage for physical therapy and pelvic floor therapy is crucial for those who require these services. While the therapy cap limits may initially seem restrictive, it is important to remember that additional coverage is available when deemed medically necessary. It is essential to consult with your medical providers and insurance company to ensure you have all the necessary information about coverage and costs.

Feel empowered and informed about your pelvic health, and share this guide to help spread awareness on the importance of understanding Medicare coverage for physical therapy. And be sure to explore our other guides at Pelvic Floor Therapy to gain essential knowledge about pelvic floor health for you and your loved ones.