Medicare Part A covers short-term PT that is provided only if you have just been released from a hospital or rehab facility. You must require skilled care and are recovering from an acute medical condition. During the first 8 weeks of therapy, you can expect to receive between 16-20 PT visits. Medicare Part A pays 100% of all PT costs and the service is provided by a hospital or home health agency.
Medicare Part B offers longer-term PT and treats physical impairments that affect your ability to function in your daily environment. PT under Medicare Part B can continue for as long as it is considered medically necessary. In the first 8 weeks you can receive between 40-48 PT visits. Medicare Part B pays 80%, of all costs and the remaining 20% is paid through a secondary insurance. Medicare Part B PT is provided through a physical therapy agency.
Here are the differences
Medicare Part A covers PT and OT services after leaving a hospital or rehabilitation center. The goal is to treat an acute condition. The service is temporary
Reasons for Part A physical therapy:
- The patient must require skilled care, i.e. they need to be seen by a nurse regularly.
- The patient must be recovering from an acute medical condition or acute functional decline.
- The patient must be considered homebound, i.e. not be able to leave the home due to physical or functional impairment.
How to the service is provided:
Medicare Part A Physical Therapy/occupational therapy services are provided by a hospital or home health agency.
- Medicare Part A PT/OT services is only continues while the patient is receiving skilled care, that is visited regularly by a nurse.
- The goal of Medicare Part A PT/OT is to get the patient safe and functional in their home.
- The average number of visits under Medicare Part A is 16-20 in an 8 weeks period.
- Medicare Part A covers 100% of the cost.
- Some of the reason to consider Medicare Part A PT/OT are chronic obstructive pulmonary disease, congestive heart failure, pneumonia, recent joint replacement
Medicare Part B covers PT and OT services at home through a physical therapy agency. The goal is to optimize function and safety in the patient’s home. The therapy will continue as long as it is considered medically necessary.
Reasons for Medicare Part B physical therapy:
- The patient wishes to achieve/maintain a higher level of functioning.
- The patient completed Part A PT/OT in the home, but still needs to achieve a higher or
- Level of functioning.
- The patient has a progressive degenerative condition such as MS or Parkinson’s and wishes to obtain maximum functional ability
- The patient is not considered homebound.
- The patient has been diagnosed with a musculoskeletal impairment, reduced endurance, balance problems, arthritis or other pain disorders, a decrease in the pain, falls, gait dysfunction, spasms /tightness, poorly fitting equipment, decreased ADLs, and wheelchair assessment and fitting.
How the service is provided:
- The services will be provided by a physical therapy agency.
- The average number of visits a person will receive in an 8-week period is 40-48 hours.
- The rehab is more intense than PT.OT under Medicare Part A.
- Medicare Part B will cover 80% of the cost of PT/OT; a secondary insurer pays the remaining fee.