Does Medicaid cover physical therapy?
Last verified:
Yes for children and for expansion adults; for other adults, only where the state has adopted the optional benefit, which most have, usually with visit limits. Federal rule: optional; mandatory in expansion plans.
What federal law says
Physical therapy is an optional benefit under 42 CFR 440.110(a), and most states have adopted it. The common limits are a number of visits per year, prior authorization after an initial block, and a requirement that a physician prescribe it.
For expansion adults, rehabilitative and habilitative services and devices are an essential health benefit, so the alternative benefit plan has to cover physical therapy; visit limits still apply but cannot be lower than the state's benchmark plan.
Physical therapy delivered as part of home health after a hospital stay is handled differently: home health is mandatory, and therapy at home can be covered as part of it in states that include it in their home health package.
Children under 21
For anyone under 21, the EPSDT benefit requires the state to cover every Medicaid-coverable service that is medically necessary to correct or improve a condition, whether or not adults in that state get it.
What to ask your state plan
- Ask how many visits are covered before authorization is needed, and get the prescription to state the diagnosis and expected duration.
- Occupational and speech therapy are separate optional benefits with their own limits.
- Find your state's agency, program name and phone on Medicaid by state.
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Common questions
Does Medicaid cover physical therapy?
Yes for children and for expansion adults; for other adults, only where the state has adopted the optional benefit, which most have, usually with visit limits.
Does Medicaid cover physical therapy for children?
For anyone under 21, the EPSDT benefit requires the state to cover every Medicaid-coverable service that is medically necessary to correct or improve a condition, whether or not adults in that state get it.
How do I find out whether my state's Medicaid covers physical therapy?
Three places. Your plan's member handbook or benefit summary, which lists the covered services and limits; the state Medicaid agency's provider manual for the service, which is public and states the medical-necessity criteria; and the member services line on your card, which can run a coverage check for a specific procedure code. Our state pages list each agency's phone and portal.
Sources
- 42 CFR 440.110 (physical therapy, occupational therapy, speech and hearing services)
- 42 CFR 440.347 (essential health benefits in alternative benefit plans)
- 42 CFR 440.70 (home health services, medical supplies and equipment)
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