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  • Mary McLendon

How Medicare Changes Affect Your Physical Therapy Treatment


We all use the New Year as an opportunity to implement change into our lifestyles, and Medicare is no exception. This year Medicare has implemented some change, impacting nearly 50 million Americans who participate in Medicare programs.

At Mizuta & Associates Physical Therapy, we have a number of patients enrolled in various Medicare programs that allow access to health care. Medicare is issued to people 65 and older as well people under 65 with permanent disabilities. Medicare is broken up into separate “parts,” with each part covering different types of services.

In dealing with physical therapy benefits, we ask Medicare patients if they are enrolled in Part B. Part A covers hospital care where Part B covers outpatient services. If a patient receives physical therapy treatment at our outpatient clinic, he or she is getting an outpatient service under part B; however, if a patient is admitted to a hospital and receives physical therapy treatment while they are in the hospital, this treatment would be labeled as an inpatient service and covered under Part A of Medicare’s benefits.

Past Medicare coverage

Originally under Part A, Medicare enrollees had unlimited physical therapy visits at hospitals as inpatients as well as attending “outpatient therapy” inside a hospital, but under Part B at outpatient freestanding clinics, visits were limited. Mizuta & Associates is considered an outpatient facility; therefore Medicare patients would have had a fixed amount of physical therapy visits. This was due to a financial cap of $1,860 put in place by Medicare for outpatient physical therapy, meaning a patient could receive roughly 16 visits under Medicare Part B per calendar year.

Current Medicare coverage

Recently, Medicare has implemented changes that impacts physical therapy benefits for all enrollees. Under the “new” Medicare, both outpatient therapies received at a hospital and outpatient physical therapy in a freestanding clinic has financial caps. This combined amount is $3,700, resulting in$1,840 for outpatient services at a hospital services and $1,860 for outpatient services at a freestanding clinic. When patients can no longer receive physical therapy at the hospital due to the new inpatient limitations, the patient is free to seek additional care from a freestanding clinic. We will do our best to keep all of the Medicare patients up to date of any other changes in 2013.

#MedicareCoverage #MedicareCap

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