“Physiotherapists are movement experts,” says Roger Herr. American Physical Therapy Association (APTA) Chairman. They are especially important for older people, considering: Half of the physical therapist's patients The number of people aged 65 and over is expected to increase further as the population ages.
As part of their scope of practice, physical therapists provide assessment, consultation, education, and treatment to improve balance, mobility, strength and endurance, coordination, and flexibility, Herr says.
Common conditions treated with physical therapy include: osteoarthritisback pain, urinary incontinence.
„Physical therapy can also be helpful as a preventive measure to prevent falls, such as when your legs shake, and it can also help with recovery after a fall or surgery,“ says Herr.
Medicare Coverage for Physical Therapy Services
If you need physical therapy whether you are staying in a facility such as a hospital or nursing home, or at home, Medicare provides coverage to manage chronic diseases Multiple sclerosis (MS), to treat an injury or illness, or to enable you to maintain your independence. Medicare does not require an order or referral, but a doctor, nurse, clinical nurse specialist, or physician assistant must certify that the service is medically necessary.
Medicare Part A intention Complete coverage of inpatient physical therapy for The first 60 days after the deductible is met., only when skilled nursing and/or rehabilitation services are required on a daily basis. After that, you will have to pay out-of-pocket costs.
outpatient insurance, This includes visits to physical therapy clinics and to the homes of older adults who are not homebound. Medicare Part B. After you meet your annual deductible, Medicare pays 80% and you pay 20% of the amount approved by Medicare.
If you haven't checked your coverage recently, you may be eligible for more services.
„Medicare coverage of physical therapy changed in 2018,“ says author Diane Omdahl. medicare for you He is also the co-founder of a Medicare advisory firm. 65 corporations.
“Prior to that, there were limits on coverage. This rule was changed to allow Medicare to cover an unlimited amount of medically necessary outpatient physical therapy services per calendar year,” Omdahl says.
Medicare Advantage Coverage for Physical Therapy Services
„Medicare Advantage Plans may require prior approval before approving physical therapy treatment,” says Herr. Physical therapists may be required to perform evaluations and submit treatment plans for insurance coverage approval, Herr explains.
Once approved, Medicare Advantage plans provide the same coverage as Medicare Parts A and B, with some exceptions. Medicare Advantage plans have different deductibles, may require members to use physical therapy services in-network, and may require more frequent audits and reviews to minimize costs and reduce overutilization of services. It may be necessary to do some things, says Herr.
Medicaid coverage for physical therapy services
medicaid The scope of physical therapy services is Optional benefits depending on stateSo you have to check what you check. Benefits your state offers.
Scope of Occupational Therapy and Speech Pathology
In addition to physical therapy, Medicare, Medicare Advantage, and Medicaid typically provide similar coverage for other rehabilitation therapies as long as they are deemed medically necessary, Herr said.
This too occupational therapyor assistance with activities of daily living (such as bathing and dressing), managing the home, and reintegration into the community to maintain current abilities or slow decline.
Also, speech pathologyproviding support for speech, language, swallowing, and cognitive skills to maintain or improve current function or slow decline.
Which is better: outpatient physical therapy at a facility or physical therapy at home?
Although all outpatient treatments are covered by Medicare Part B, you may be wondering if receiving physical therapy at home is as helpful as being offered in a facility.
„Physical therapy facilities may have additional equipment and resources than what a physical therapist can provide at home,“ says Herr.
Additionally, Herr says wait times for physical therapy services at a facility can be shorter than for physical therapy services provided at home.
„Going out for physical therapy also helps with socialization, which can be hindered when dealing with mobility issues,“ says Herr.
However, for some patients, home-based outpatient treatment provides an opportunity to address environmental issues within the home and ensure that the individual can manage safely and independently in their own environment. Home-based treatment can also help improve access to treatment for people who don't have reliable transportation, Herr says.
Difficulty finding a physical therapist
Medicare covers physical therapy, but It's hard to find a physical therapist.
“The physical therapist shortage peaked during the pandemic, but we still have double-digit vacancies,” Herr said.
Other factors continue to contribute to the continued shortage, according to a study. KFF News Report. One is that physical therapists are required to have a Ph.D., which reduces the number of students entering the field. Another is that Medicare has reduced physical therapy reimbursement by 9% over the past four years, leading to lower staffing levels.