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Does Medicare cover physical therapy for back pain?

Back pain is one of the most frequent complaints of patients to their doctor. The aches and soreness can be debilitating, limiting one’s range of motion and interrupting daily activity. According to Georgetown University’s Health Policy Institute, roughly 83 million days of work are lost each year due to back pain, affecting adults of all ages and income. For those with Medicare benefits who suffer from back pain, many tests, items and services are covered.

Medicare Part A covers back pain treatments needed by hospital in-patients, while Medicare Part B helps pay for medically necessary outpatient physical therapy. For physical therapy, patients typically pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Previously, there were limits to how much outpatient therapy was covered; Medicare law no longer limits how much it pays for medically necessary outpatient therapy services in a calendar year. In 2021, Original Medicare covers up to $2,110 for physical therapy before requiring a doctor or health care provider to deem services medically necessary.

The amount of money patients will owe for treatments will depend on the type of insurance, how much a doctor charges, whether the doctor agrees to accept the Medicare-approved amount as full payment for covered services (also known as accepting assignment) and where treatment is received.

Medicare-covered outpatient therapy includes therapy received at therapists’ or doctors’ offices, skilled nursing homes, comprehensive outpatient rehabilitation facilities and at home, depending if a patient is eligible for Medicare’s home health benefit.

Cass County Medical Care Facility’s physical therapists and physical therapist assistants provide a holistic approach to functional mobility restoration, offering strengthening and training in all aspects of functional mobility; this includes range of motion, strengthening, neurological re-education, posture, positioning, coordination, balance, bed mobility, transfers and ambulation. Staff trains and educates residents of safe and effective functional mobility, pain management, edema reduction and utilization of appropriate assistive devices to maximize safe, functional potential specific to each resident.