Does Medicare Cover Physical Therapy? (California, 2026)

Quick answer: Yes. Original Medicare covers medically necessary physical therapy, and since 2018 there is no annual dollar cap on it. Outpatient PT is covered under Part B (you pay 20% coinsurance after the Part B deductible); PT during a hospital or skilled-nursing stay falls under Part A. There is a documentation checkpoint — the KX modifier threshold — but it is not a spending limit, and covered therapy can continue as long as it stays medically necessary.

Here’s how the coverage works, what the “threshold” really means, and what you pay in 2026.

Does Medicare cover physical therapy?

Yes — physical therapy is a covered Medicare benefit when it’s medically necessary and delivered under a plan of care that a physician or qualifying provider certifies. Where it’s covered depends on the setting:

• Outpatient PT (a therapy clinic, a doctor’s office, an outpatient hospital department, or at home under outpatient therapy) → covered under Part B.
• Inpatient PT during a covered hospital stay → covered under Part A.
• PT in a skilled nursing facility (SNF) during a covered stay → covered under Part A.
• Home health PT → covered when you’re homebound and need skilled therapy, generally at no cost for the therapy itself under the home health benefit.

Most people asking “does Medicare cover physical therapy?” mean outpatient PT, so that’s the focus below.

Is there a limit on Medicare physical therapy?

This is the most common worry, and the answer is reassuring: there is no annual dollar cap and no visit limit on medically necessary outpatient physical therapy. The old “therapy cap” was permanently repealed in 2018.

What replaced it is a documentation checkpoint called the KX modifier threshold. For 2026 the threshold is about $2,480 for physical therapy and speech-language pathology combined (confirm the current figure at Medicare.gov). Here’s what it actually does:

• It is not a cap and it does not stop your coverage.
• Once your combined PT/SLP costs (what Medicare paid plus your share) reach the threshold, your therapist simply adds a KX modifier to each further claim — a note attesting that continued therapy is medically necessary and that your records support it.
• Above a second, higher review threshold, some claims may get a targeted medical review, but medically necessary therapy still gets covered.

What does covered physical therapy cost in 2026?

For outpatient PT under Part B, you generally pay:

• the Part B deductible (a set annual amount — confirm the current 2026 figure at Medicare.gov), and then
• 20% coinsurance of the Medicare-approved amount for each therapy session.

A Medicare Supplement (Medigap) policy can cover some or all of that 20% coinsurance. A Medicare Advantage plan must cover at least what Original Medicare covers, but uses its own copay structure — often a set copay per therapy visit — and may require you to use in-network therapists or get prior authorization, so check the plan’s rules.

For PT under Part A (during an inpatient hospital or covered SNF stay), the cost falls under that stay’s Part A deductible and coinsurance rules rather than the 20% outpatient coinsurance.

What physical therapy is NOT covered?

Medicare covers PT that’s medically necessary and skilled. It generally does not cover:

• Maintenance exercise or general fitness you could do on your own without a skilled therapist (though skilled therapy to maintain function in certain conditions can qualify — this is a nuanced area worth asking about),
• Wellness, conditioning, or gym-style programs, or
• Therapy that isn’t tied to a certified plan of care or medical need.

If therapy stops being medically necessary, coverage stops — which is why the plan of care and periodic re-certification matter.

How this fits the bigger Medicare picture

Physical therapy is one of the “is this covered?” questions that comes down to the same rules Original Medicare applies everywhere: is it medically necessary and skilled, and is it delivered under a proper plan of care. Our Does Medicare cover it? California guide explains those tests and links to the service-by-service guides. Related reading:

• Does Medicare cover chiropractic care?
• Does Medicare cover acupuncture?
• What does Medicare cost? Premiums, deductibles, and out-of-pocket explained
• Medigap vs. Medicare Advantage

Whether a Medicare Advantage plan’s therapy copays and network rules work for you, or whether Original Medicare plus a Medigap plan is a better fit, depends on your situation. If you’re new to Medicare and turning 65, an independent broker can walk through that comparison with you at no cost.

Frequently asked questions

Does Medicare cover physical therapy?

Yes. Original Medicare covers medically necessary physical therapy — outpatient PT under Part B, and inpatient or skilled-nursing PT under Part A — when it’s delivered under a certified plan of care.

Is there a limit on how much physical therapy Medicare will cover?

No dollar cap and no visit limit for medically necessary outpatient PT. The old therapy cap ended in 2018. There’s a KX modifier threshold (about $2,480 for PT and speech therapy combined in 2026), but that’s a documentation checkpoint, not a limit on coverage.

What is the KX modifier threshold?

It’s the point at which your therapist must add a billing note (the KX modifier) attesting that continued therapy is still medically necessary. Reaching it does not stop your coverage — medically necessary therapy keeps being covered.

What will I pay for outpatient physical therapy in 2026?

On Original Medicare, you pay the Part B deductible and then 20% coinsurance of the Medicare-approved amount per session. A Medigap policy may cover some or all of that 20%; a Medicare Advantage plan uses its own copays and network rules. Confirm current amounts at Medicare.gov.

Does Medicare cover physical therapy at home?

Yes, in two ways: through the home health benefit if you’re homebound and need skilled therapy (generally no cost for the therapy itself), or as outpatient PT under Part B if you receive covered outpatient therapy at home.

Does Medicare cover physical therapy after surgery or a stroke?

Yes, when it’s medically necessary and under a plan of care. There’s no dollar cap, so an extended course of rehab after surgery, a stroke, or a fall can be covered — your provider documents ongoing medical necessity via the KX modifier once you pass the threshold.

Sources & official references

• Medicare.gov — Physical therapy coverage
• Medicare.gov — Medicare costs (Part B deductible and coinsurance)
• California Health Advocates (HICAP) — free Medicare counseling

This article is educational and not individualized advice. Matt Medicares is an independent insurance brokerage and is not affiliated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, or any government agency. We do not offer every plan available in your area. To review all of your options, contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) — in California, that’s HICAP. Medicare figures reflect 2026 and can change annually.