When an injury, surgery, or chronic pain limits your ability to move freely, physical therapy can make a big difference. But one of the first questions many people ask is, “Is physical therapy covered by insurance?” The short answer is yes—most health insurance plans cover at least part of the cost for physical therapy. However, the amount covered, the number of sessions allowed, and the out-of-pocket expenses vary depending on your insurance provider and plan type.
In this article, we’ll break down how insurance coverage for physical therapy works, what you can expect to pay, and tips to get the most out of your benefits.
Understanding How Physical Therapy Coverage Works
Before booking your first appointment, it helps to understand how physical therapy insurance coverage works. Most major health insurance plans, including those from employers, the Affordable Care Act marketplace, Medicare, and Medicaid, recognize physical therapy as a medically necessary treatment. That means it’s usually covered if your doctor prescribes it to help recover from surgery, injury, or manage a medical condition.
However, just because it’s covered doesn’t mean it’s completely free. Most plans have cost-sharing features, such as copays, coinsurance, or deductibles that you must meet before insurance kicks in. For example, you might pay $20–$50 per visit if your deductible has already been met, or you could be responsible for 20% of the total cost if coinsurance applies.
Each insurance plan also limits how many therapy sessions are covered per year. Some plans may cover 20 to 30 visits annually, while others base the limit on medical necessity determined by your provider.
When Is Physical Therapy Covered by Insurance?
Physical therapy is covered by insurance when it’s deemed medically necessary. That means a licensed healthcare provider must recommend it as part of a treatment plan for a specific health issue.
Common reasons physical therapy is covered include:
- Recovery after surgery or hospitalization
- Injury rehabilitation (like fractures, sprains, or joint injuries)
- Stroke or neurological recovery
- Chronic pain management (such as back pain or arthritis)
- Postpartum recovery and pelvic floor therapy
- Mobility or balance improvement for seniors
Your insurance company may require documentation from your doctor or the physical therapist to approve ongoing treatment. If the therapy is considered preventive or not medically necessary—such as for fitness improvement or general wellness—it likely won’t be covered.
Is Physical Therapy Covered by Insurance Without a Referral?
This depends on your insurance provider and state laws. Some states allow direct access to physical therapists, meaning you can see one without a doctor’s referral. However, even in direct access states, your insurance might still require a referral for reimbursement.
For instance, some private insurance plans and Medicare require a physician’s order before they’ll cover therapy sessions. It’s always best to double-check with both your insurer and your physical therapy clinic before starting treatment.
How Much Does Physical Therapy Cost Without Insurance?
If you don’t have insurance, the cost of physical therapy can add up quickly. The average cost per session in the U.S. ranges between $75 and $200, depending on location, clinic type, and the complexity of your condition.
For example, an initial evaluation might cost $150, while follow-up visits could be $100 each. If you need several sessions per week over multiple months, the total expense could reach $1,000 to $2,000 or more.
Some clinics offer self-pay discounts or payment plans for uninsured patients. In certain cases, you can also find community health centers or physical therapy schools that provide treatment at reduced rates.
Does Medicare Cover Physical Therapy?
Yes, Medicare does cover physical therapy when it’s medically necessary. Under Medicare Part B, outpatient physical therapy services are included. You’ll typically pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Medicare no longer has a strict annual cap on physical therapy costs, but your provider must continue to document progress to justify ongoing treatment. Once you reach a certain spending threshold (around $2,300 per year), Medicare may review your therapy plan more closely.
If you have Medicare Advantage (Part C), coverage varies depending on the specific plan, but most include similar benefits to traditional Medicare.
Does Medicaid Cover Physical Therapy?
Medicaid coverage for physical therapy varies by state, but it’s generally included as part of the rehabilitation and habilitation services category. For adults, there may be limits on the number of visits per year, while for children, Medicaid usually provides full coverage under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
If you’re on Medicaid, check your state’s program website or contact your caseworker for exact details about physical therapy coverage and any pre-authorization requirements.
Private Health Insurance Coverage for Physical Therapy
If you have private or employer-sponsored insurance, your plan will likely cover physical therapy—but the details matter. Most private plans include coverage under rehabilitative services in their summary of benefits.
Here are a few things to check:
- Copay or coinsurance amounts per visit
- Deductible requirements
- Annual visit limits
- Network restrictions (you’ll save more with in-network providers)
- Pre-authorization or referral rules
Plans from providers like Blue Cross Blue Shield, Aetna, UnitedHealthcare, and Cigna all include physical therapy benefits, but coverage levels and paperwork requirements differ.
Tips for Getting the Most from Your Physical Therapy Insurance Coverage
Maximizing your insurance benefits takes some planning. Here are a few smart tips:
- Verify coverage before starting: Call your insurer to confirm your benefits, limits, and what’s required for approval.
- Stay in-network: Out-of-network care usually costs more or may not be covered.
- Ask about visit limits: Knowing your session cap can help you pace treatment or request an extension if needed.
- Keep records: Always save documentation from your doctor and therapist for insurance claims.
- Discuss costs upfront: Ask the clinic for an estimate of what your out-of-pocket expenses will be based on your plan.
What If Your Insurance Doesn’t Fully Cover Physical Therapy?
Even if your plan doesn’t cover all sessions, you still have options. Many physical therapists offer cash discounts, payment plans, or can help you appeal to your insurer for additional visits.
If your insurance denies coverage, ask for a written explanation and see if your doctor can submit more detailed medical documentation. Sometimes, additional notes proving medical necessity can get your claim approved.
You can also consider using Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) to pay for therapy with pre-tax dollars, which helps lower the financial burden.
Final Thoughts: Is Physical Therapy Covered by Insurance?
So, is physical therapy covered by insurance? In most cases, yes—especially when it’s medically necessary and prescribed by a doctor. The key is understanding your specific plan’s rules, limits, and costs before you begin treatment.
Having insurance coverage for physical therapy can make recovery more affordable and accessible. Whether you’re healing from surgery, managing chronic pain, or improving mobility, therapy is an essential part of staying healthy—and your insurance can help you get the care you need without breaking the bank.