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Medicare clarifies coverage for physical therapy

Created date

January 6th, 2017
Physical therapy that helps you stay at your current level of functioning should be covered by Medicare.

Physical therapy that helps you stay at your current level of functioning should be covered by Medicare.

If you have been denied additional physical therapy services because you have reached your so-called maximum improvement, you might want to appeal that decision.

Maintenance, not improvement

The maximum-improvement standard was never an official part of Medicare coverage policies, and it’s not entirely clear why it was put into effect. A 2013 class action settlement specified that the standard for continued physical therapy should be health maintenance, not improvement. In other words, if therapy can help someone stay at their current level of functioning or prevent deterioration, it should be covered. 

For example, someone with chronic lung disease who receives therapy to maintain their activity level might be able to avoid a hospitalization for shortness of breath or pneumonia. People with neurological conditions such as Alzheimer’s disease or Parkinson’s disease could reduce the rate of decline and minimize the chance of falls or immobility-related complications.  

The court ruled that Medicare needs to come up with a way to notify beneficiaries of the standards for physical therapy coverage. In the meantime, check with your doctor, who can provide the necessary information about whether physical therapy will continue to be a benefit for your health. 

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