Does Medicare cover occupational therapy?

What occupational therapy does Medicare cover?

Medicare Part B covers medically necessary outpatient occupational therapy, which Medicare.gov describes as therapy to help you perform activities of daily living, like dressing or bathing.

You can get occupational therapy to help improve or maintain your current capabilities, or to slow your rate of decline. Medically necessary means the services are needed to diagnose or treat an illness, injury, condition, disease or its symptoms and meet accepted standards of medicine.

Who qualifies for Medicare coverage of occupational therapy?

Medicare Part B covers outpatient occupational therapy when your doctor or other health care provider certifies that you need this care. Besides a doctor, that provider can be a nurse practitioner, clinical nurse specialist or physician assistant, and the therapy must be medically necessary.

What do I pay for occupational therapy with Medicare?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for medically necessary outpatient occupational therapy. The Medicare-approved amount is the payment amount Original Medicare sets for a covered service; when your provider accepts assignment, Medicare pays its share and you pay your share of that amount.

What you owe also depends on any other insurance you have, how much your doctor charges, whether your doctor accepts assignment, the type of facility and where you get the therapy, so ask your provider what your care will cost.

Is there a limit on how much occupational therapy Medicare covers?

No. There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year. Your doctor may still recommend services that Medicare doesn't cover, or more often than Medicare covers them, which could mean extra costs for you, so ask why a service is recommended and what Medicare will cover.

Does Medicare cover occupational therapy at home or in a facility?

Yes. Medicare also covers occupational therapy at home, in a skilled nursing facility and in an inpatient rehabilitation facility, under the rules for each setting:

• At home: Medicare home health coverage includes occupational therapy if you're homebound, need part-time or intermittent skilled services, a doctor or other provider sees you in person and orders the care, and a Medicare-certified home health agency provides it. Your provider must first order occupational therapy along with nursing care, physical therapy or speech-language pathology; after that you can keep getting occupational therapy on its own. You pay nothing for covered home health services.
• In a skilled nursing facility: Part A covers occupational therapy if it's needed to meet your health goal, after a qualifying inpatient hospital stay of at least 3 days in a row. In 2026 you pay $0 a day for days 1 to 20 after the $1,736 Part A deductible (unless you already paid it for hospital care in the same benefit period), then $217 a day for days 21 to 100.
• In an inpatient rehabilitation facility: Part A covers rehabilitation services, including occupational therapy, when your provider certifies that you need intensive rehabilitation, continued medical supervision and coordinated care. See Medicare inpatient rehab coverage.

Does Medicare Advantage or Medigap change occupational therapy coverage?

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and some offer extra benefits; rules and costs vary by plan. A plan may have different out-of-pocket costs, may ask you to use doctors and other providers in its network, and may require approval (prior authorization) before it covers certain services. See how Medicare Advantage differs from Original Medicare.

A Medigap (Medicare Supplement Insurance) policy helps pay your share of out-of-pocket costs in Original Medicare, like coinsurance and deductibles, such as the 20% coinsurance for covered occupational therapy.