Is physical therapy covered in the US? Medicare, insurance and cost

Medicare

• Part B covers outpatient physical therapy when it is medically necessary. A doctor, nurse practitioner, physician assistant or clinical nurse specialist must certify your plan of care.
• There is no limit on how much Medicare pays for medically necessary outpatient therapy in a year. The old therapy caps were repealed in 2018.
• In 2026, once your PT and speech therapy costs reach $2,480 for the year, your therapist adds a modifier (KX) to confirm the care is still medically necessary. Above $3,000, claims may be reviewed.
• You pay 20% of the Medicare-approved amount after the Part B deductible.

In 2026, Medicare’s national approved amount ranges from about $30 to $100: the lower figure is for each 15-minute unit of therapeutic exercise and the higher one is for an evaluation. A typical visit includes several units, and amounts vary by location.

Do you need a referral?

All 50 states and the District of Columbia allow some form of direct access, meaning you can see a physical therapist without a referral, although some states still attach conditions. Your insurance plan may still require a referral or prior authorization before it pays, so check first. Medicare doesn’t require a referral, but a doctor or other practitioner must certify your plan of care.

Private insurance

• Rehabilitative services are one of the 10 essential health benefits, so Marketplace plans cover physical therapy, although what’s included varies by state.
• Most plans limit visits; 20 visits a year is a common example. Large employer and self-insured plans aren’t bound by the essential health benefit rules.
• Some insurers manage physical therapy through a separate company and may require authorization after a set number of visits; UnitedHealthcare, for example, uses Optum.

Medicaid

Physical therapy is an optional Medicaid benefit for adults, so coverage and visit limits vary by state. Children under 21 are covered for medically necessary care through Medicaid’s EPSDT benefit.

Work and accident injuries

Workers’ compensation pays for medical treatment of work injuries, including physical therapy, through your state’s program. Auto insurance medical payments or personal injury protection (PIP) coverage may pay for treatment after a car accident.

Self-pay prices

Published cash prices we found ranged from about $75 to $150 a visit, with evaluations at the top of that range. Ask the clinic what a visit includes and for a written Good Faith Estimate.

If you’re uninsured or paying yourself

Under the No Surprises Act, if you don’t have insurance or choose not to use it, you have the right to a written Good Faith Estimate when you schedule a service at least 3 business days ahead, or whenever you ask. If your final bill from a provider is at least $400 more than its estimate, you can dispute it with the federal patient-provider dispute process within 120 days of the bill date. There is a small fee.

Ask whether a cash price includes the doctor, the facility, imaging guidance, sedation and the medicine itself, because published prices differ in what they cover.

Paying with an HSA or deducting it

Medical procedures and physical therapy that treat a medical condition are generally qualified medical expenses for a health savings account (HSA) or flexible spending account (FSA). In 2026 you can put up to $4,400 (self-only) or $8,750 (family) into an HSA if you have a qualifying high-deductible plan. If you itemize, unreimbursed medical expenses above 7.5% of your adjusted gross income can be deducted.

If you are denied

• Private plans: ask for the denial and the policy it relies on in writing. You have 180 days from the denial notice to file an internal appeal; in urgent cases the plan must decide within 72 hours. If the plan still says no, you can ask for an independent external review within 4 months, and the insurer must accept the reviewer’s decision.
• Original Medicare: you have 120 days from the date on your Medicare Summary Notice to ask for a redetermination.
• Medicare Advantage: ask your plan for a reconsideration within 65 days of the denial notice.
• Your doctor’s office can often help with a peer-to-peer review or a letter of medical necessity. Your state insurance department can also help with complaints about private plans.

Frequently asked questions

How many physical therapy visits does Medicare cover?

There is no fixed number or yearly dollar cap. Medicare keeps paying as long as the therapy is medically necessary; above $2,480 a year (2026, PT and speech therapy combined), your therapist must confirm that it still is.

Can I see a physical therapist without a referral?

Yes, every state allows some direct access. But your insurance may still need a referral or prior authorization to pay, so check your plan.

How much is physical therapy without insurance?

Published cash prices we found ranged from about $75 to $150 a visit. Ask the clinic for a written Good Faith Estimate.

This page explains how coverage usually works in the United States, using the public Medicare, insurer, government and provider sources listed above. It is general information, not medical, insurance, financial or legal advice, and it does not recommend any treatment, plan or provider. Coverage depends on your plan, your diagnosis and where you live, and rules and prices change, so confirm with your doctor, your plan or Medicare, and the provider before you decide. Protocol Archive is independent and is not affiliated with Medicare, CMS or any insurer.