Medicaid Physical Therapy Services

Physical therapy services are defined as “the evaluation, diagnosis and treatment of physical disability, injury or disease using physical and mechanical means, including but not limited to, heat, cold, light, air, water, sound, electricity, massage, mobilization and therapeutic exercise with or without assistive devices”.  Also included in physical therapy services are the execution and analysis of tests and evaluations to determine the type of disabilities or injuries which in turn will establish what kind of treatment is required.

Medicaid physical therapy services are optional benefits in states that do cover them. In order for people covered by Medicaid to obtain physical therapy services, they must have recommendations coming from their doctors that they need this kind of treatment. Recommendations may also come from licensed physical therapists or other licensed practitioners of the healing arts, again dependent on state Medicaid eligibility. The recommendations must prove that patients necessitate physical therapy services which can then bring them back to the best possible physical functional abilities. Medicaid coverage for physical therapy services typically include the equipment and other medical items needed for treatment.

There are currently 33 states that provide Medicaid physical therapy services coverage although it is under optional medical service category. This means that the states do not consider physical therapy services as a mandatory or necessary procedure. They also often have accredited physical therapy clinics or providers where Medicaid eligible patients can get their treatments and physical therapy needs. Typical also to states that have Medicaid physical therapy services are what is called as physical therapy caps, or a limit on how often a certain Medicaid recipient can get physical therapy services in a certain amount of time or up to what amount Medicaid will reimburse for physical therapy services.

Also common to states that do offer is that they typically provide this coverage to patients who are below the age of 21. Medicaid physical therapy services can still be received by children who already get physical therapy services through school health programs. Frequently, states limit the Medicaid physical therapy services to eight 15 minute sessions in a day. And the coverage is only up to a year.

There are states that also provide adults Medicaid physical therapy services, but only as outpatient services from an accredited physical therapy clinic. Usually, there is an annual limit of an average of $1,500.

In order for physical therapists and physical therapy clinics to be accredited with state Medicaid physical therapy services programs, they must be licensed in accordance with state requirements. Physical therapists must be registered and licensed by the state to practice and may hire licensed physical therapy assistants to help them. Only licensed physical therapists can do patient evaluation for treatment and they must supervise physical therapy assistants during therapy sessions.

With the recent health policy adjustments proposed by the Obama administration, a number of states that provide Medicaid physical therapy services are thinking of further cutting down or eliminating their programs for Medicaid physical therapy services. This would take away crucial treatment for children and patients that really need physical therapy services.


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