Physical Therapy for Medicare Beneficiaries
If you have Medicare Part B, you can receive physical therapy at Tualatin Valley Physical Therapy. We’ll help you understand coverage, documentation, and costs before we start.
Who This Page is For
We Help Our Medicare Patients With:
Neck, back, shoulder, hip, knee, and ankle pain
Balance issues / fall risk
Post-op rehab (joint replacements, repairs)
Tendon/overuse injuries that limit walking, lifting, or daily activities
Deconditioning after illness or inactivity
How Medicare PT Works Here
Medicare requires that physical therapy be:
Medically necessary
Documented with a plan of care and measurable goals
Periodically reviewed and certified by a physician or qualified provider (certification timing matters)
Our job is to deliver great care and keep the documentation clean so you don’t get stuck in billing confusion.
What Options Do Medicare Beneficiaries Have?
Option A: We submit Medicare claims
We are able to submit claims to Medicare Part B.
If Medicare approves the claim, you’re typically responsible for your standard cost-sharing (for example, coinsurance and any unmet deductible).
What you can expect
We confirm what documentation is needed
We track all required progress reporting
Typically, once your deductible is met, you only pay 20% of the cost
Unless you have Medigap which covers the rest
We are out of network with Medicare Part C/Advantage
Option B: Private pay for non-covered/wellness services
Wellness/fitness/prevention services are available as private pay when they are not medically necessary or not billable to Medicare. When appropriate, we’ll explain the difference and keep everything transparent in writing.
Physician Certification & Plan of Care
Do I need a referral or a doctor’s signature?
You can often start PT without a referral, but Medicare has documentation rules that still apply.
At your evaluation, we create a Plan of Care (what we’re treating, why it’s medically necessary, visit frequency/duration, and goals). Medicare also requires timely certification by an appropriate provider. If you don’t currently have a PCP, we’ll help you understand realistic options and what we can/can’t do without certification.
We’ll never surprise you. If there’s a documentation issue that could affect coverage, we’ll discuss it early and in writing.
Costs
What will PT cost me?
Costs depend on Medicare coverage rules, your deductible/coinsurance status, and whether a service is billable vs. wellness.
We’ll provide:
A clear explanation of whether we’re treating under Medicare-covered care vs. non-covered wellness
Written notices when Medicare may not pay for a service (when applicable)
Straight answers about your expected out-of-pocket costs
Transparent pricing and clear expectations are part of how we take care of people here.
Medicare PT FAQ
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We are out-of-network with Medicare Advantage (Part C) plans as they are still commercial health insurances.
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Medicare doesn’t work like a fixed “10 visits” rule. Coverage is based on medical necessity and documentation.
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If a service is likely not covered, we’ll discuss alternatives (including wellness/private pay when appropriate) and provide the proper written notice when required.
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Yes, when the goals/services are preventive/fitness-focused (not medically necessary skilled therapy), we can structure wellness services transparently.
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Your Medicare card (and any secondary insurance info)
A list of medications and key medical history
Any imaging reports you have (optional)
This page is educational and is not a guarantee of coverage or payment. Medicare coverage decisions depend on medical necessity, documentation, and applicable rules.