Will Medicare pay for Physical Therapy? Do you take Medicare?

I often get asked this and the answer is Yes.  Medicare is about 35% of Back In Motion, Sarasota Physical Therapy’s business.  We are authorized providers to provide Physical Therapy services.  Often there is little or NO COST for the Medicare recipient.  Will Medicare pay for Physical Therapy?  YES!  Medicare covers 80% of the providers services.  If the Medicare member has a secondary insurance (examples include but are not limited to:  BCBS, Aetna, Tricare, etc) the 20% co-insurance is covered.  This is the case for most of our medicare clients as MOST of our medicare clients pay nothing!  There are those few who have limits, deductibles or maximums associated with the secondary insurance.  In those cases, there may be a small member responsibility.  IF the Medicare client has a small financial responsibility DO NOT WORRY.  If you are experiencing financial hardship, we have you fill out a form and give you options so you can get the Physical Therapy you need!

Will Medicare pay for Physical Therapy
No Approval Requried

Do you take Medicare as primary and Medicaid as secondary?

Yes.  You as a Medicare recipient for the primary insurance and Medicaid as a secondary insurance will have no financial responsibility for Physical Therapy as Back In Motion Sarasota Physical Therapy.

Do I Need A Physician Prescription If I have Medicare Insurance & I Need PT?

NO!  There is still a myth out there today that a Physician Prescription is required in order to be seen by a PT in the state of Florida.  Florida is a direct access state meaning NO PHYSICIAN PRESCRIPTION IS REQUIRED to receive skilled Physical Therapy evaluation or treatment.  According to the Florida Physical Therapy Association:

“Thanks to the advocacy of the FPTA and APTA, Florida is a “direct access state.” This means you are allowed to go directly to a PT without a physician’s referral first and receive treatment for 21 days. After 21 days, the therapist will need to get a treatment plan signed by a health care practitioner licensed in Florida. This is an especially important point for our many northern residents who spend their winters in the sunny south.”

Click here for a summary of how direct access works and the physicians involvement

Will Medicare pay for Physical Therapy without a physician order?  Yes.

At Back In Motion, Sarasota Physical Therapy, we use state of the art Electronic Medical Records (EMR).  After the Physical Therapist assesses you, we input the info into our record keeping system.  We then electronically fax an easy to read one page plan to the physician for signature.  This communicates to the physician that we have seen you and what is causing your pain, injury or weakness.  It also indicates to the Doctor what types of physical therapy treatment will get you better.

Will Medicare pay for Physical Therapy
Medicare Card

Be Wary of…

  1.  The Physical Therapy Clinic who uses a Physical Therapy technician or PT aid to treat a Medicare client.  This is Medicare Fraud.  ONLY a licensed Physical Therapist (PT) or licensed Physical Therapy Assistant (PTA) is allowed to treat and subsequently bill for Physical Therapy services under the Medicare Program.  Will Medicare pay for Physical Therapy provided by a technician or aid?  Yes, they will pay however upon audit, the monies will be recouped.  An ethical PT clinic should NOT bill Medicare for services provided by a technician or aid.
  2. The physical therapist who puts you on a stationary bike, treadmill or other non-skilled machine and walks away from you.  Those types of treatment must be skilled meaning the PT is giving you medically necessary verbal cues, tactile cues or corrective assistance.  Is your Physical Therapist or Physical Therapists Assistant staying with you or walking away to treat someone else? Will Medicare pay for Physical Therapy that is “unskilled”?  Again, the answer is Yes, they will pay however upon audit, the monies will be recouped as this should NOT occur.

Direct one on one care for most types of treatment MUST be provided.  exceptions of one on one are:  E-stim, traction, application of heat or ice.  Most other therapy methods the PT performs with you should BE WITH YOU ONLY.  If your PT is treating you and other clients AT THE SAME time, that is a problem.

A list of Health Insurances that Back In Motion Sarasota Physical Therapy accepts and is “In-Network” with can be found on our website, but if it’s not listed, simply call or email us to inquire.  Info@BackInMotionFL.com or (941)925-2700.  Our list is growing, so if your health insurance is not listed, just call!

Do NOT delay, our schedule is filling fast due to the seasonal rush!  Call today, you do not need a physician prescription and you will get quality results oriented ethical Physical Therapy services.

About the Author Tim Burnell, PT

Tim Burnell is the Lead Physical Therapist at Back In Motion Sarasota. He has over two decades of clinical experience. He takes pride in getting to the root of the problem which helps get his clients better...Faster! He is a family man & enjoys spending time with the love of his life, Monique. He has 2 children & a dog named Annie. Tim's son, Andre' is 11 years old and his daughter Joliebelle (nicknamed Pooky) is 7 years old. He enjoys visiting his wife's side of the family in New Orleans and his side of the family in Vermont. Tim grew up in Vermont, went to Physical Therapy School in Alabama, got his first job at Tulane Hospital in New Orleans and moved to Sarasota Florida after Hurricane Katrina in 2006.

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