Outpatient therapy under Part B
Original Medicare Part B covers outpatient physical therapy when:
- It is medically necessary to treat an injury, illness or condition.
- A doctor, nurse practitioner, physician assistant or clinical nurse specialist certifies a plan of care and recertifies it as needed.
- A physical therapist, or a provider qualified to give therapy, gives the care, and the provider accepts Medicare.
You pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026). Medigap policies pay all or part of that coinsurance. There is no yearly dollar cap; above a threshold CMS sets each year, the therapist adds a statement that the care is medically necessary.
Where you get therapy
| Setting | Which part of Medicare |
|---|---|
| Outpatient clinic, therapist's office, hospital outpatient department | Part B |
| At home under the home health benefit | Part A or Part B home health |
| Inpatient hospital or inpatient rehabilitation facility | Part A |
| Skilled nursing facility after a qualifying hospital stay | Part A |
With a Medicare Advantage plan
Medicare Advantage plans must cover the same medically necessary therapy as Original Medicare, but they set their own cost sharing and often require prior authorization after a number of visits or the use of in-network therapists. Before you start, check that the clinic is in your plan's network and ask whether authorization is needed. In rural Oregon counties, network clinics can be far apart, so ask about telehealth visits too.
Tips for Oregon patients
- Ask the clinic whether it accepts Medicare assignment.
- Keep your plan of care: it shows what is covered and for how long.
- If a provider says Medicare will stop paying, ask for the written notice. You can appeal; see Medicare appeals in Oregon.
Related questions
Does Medicare cover chiropractic in Oregon?
What Part B pays for spinal care.
Does Medicare cover acupuncture in Oregon?
Chronic low back pain rules.
Does Medicare cover home health in Oregon?
Therapy at home.
Does Medicare cover skilled nursing care in Oregon?
Rehab after a hospital stay.
Sources
- Medicare.gov — Physical therapy services
- CMS — Jimmo settlement: skilled maintenance care
- CMS — Therapy services
More questions in this guide
- Does Medicare cover acupuncture in Oregon?
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- Does Medicare cover annual physicals in Oregon?
- Does Medicare cover assisted living in Oregon?
- Does Medicare cover bone density tests in Oregon?
- Does Medicare cover cataract surgery in Oregon?
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- Does Medicare cover hearing aids in Oregon?
- Does Medicare cover home health care in Oregon?
- Does Medicare pay for in-home caregivers in Oregon?
- Does Medicare cover mammograms in Oregon?
- Does Medicare cover me when I travel or spend winters outside Oregon?
- Does Medicare cover medical marijuana in Oregon?
- Does Medicare cover memory care in Oregon?
- Does Medicare cover mental health care in Oregon?
- Does Medicare cover naturopathic doctors in Oregon?
- Does Medicare cover nursing home care in Oregon?
- Does Medicare cover oxygen therapy in Oregon?
- Does Medicare cover prostate cancer screening in Oregon?
- Does Medicare cover psilocybin therapy in Oregon?
- Does Medicare cover skilled nursing care in Oregon?
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- Does Medicare cover wheelchairs in Oregon?
Part of the guide: Learn Medicare — the Oregon starter guide · All questions
Frequently asked questions
Is there a cap on Medicare physical therapy?
No. The old therapy cap ended in 2018. Above a yearly amount CMS sets, your therapist must confirm the care is still medically necessary, and Medicare may review the records, but covered care continues.
Does Medicare cover therapy to keep me from getting worse?
Yes. Medicare covers skilled maintenance therapy when you need a therapist's skills to keep your current condition or slow decline, not only when you are improving.
Do I need a doctor's order?
Original Medicare pays when a doctor or other qualified provider certifies your therapy plan of care. Medicare Advantage plans may also require referrals or prior authorization.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
