A straightforward explanation from a licensed physical therapist who deals with Medicare every day. Updated January 2026.

If you're reading this, you probably have questions about Medicare coverage for in-home physical therapy. Maybe your doctor mentioned it. Maybe you're recovering from surgery and can't make it to a clinic. Or maybe you're worried about falling and wondering if Medicare will pay for someone to come to your home.

I'm Mike Zagare, a licensed physical therapist here in Greenville, SC. I've been working with Medicare patients for over 20 years, and I deal with Medicare coverage questions literally every single day.

So let me give you straight answers—no confusing insurance jargon and no vague “it depends.” Just clear information about what Medicare covers, how to qualify, and what it actually costs.

Does Medicare Cover In-Home Physical Therapy in Greenville, SC?

Yes — Medicare does cover in-home physical therapy in Greenville and Upstate South Carolina, but coverage depends on how your care is classified under Medicare.

Quick Medicare FAQs About In-Home Physical Therapy

Does Medicare require homebound status for in-home physical therapy?

Medicare requires homebound status only when in-home physical therapy is provided under Medicare Part A (the home health benefit). If physical therapy is billed under Medicare Part B (outpatient physical therapy), homebound status is not required.

What’s the difference between Medicare Part A and Part B for in-home physical therapy?
Medicare Part A covers in-home physical therapy as part of home health care when you are homebound and under a doctor’s plan of care. Medicare Part B may cover physical therapy delivered in the home as an outpatient service when homebound criteria are not met, typically with coinsurance.

Medicare Part A Home Health Coverage for In-Home PT

Medicare Part A (Home Health) Covers In-Home Physical Therapy When All of the Following Are True:

• You are homebound

• A doctor orders and oversees your plan of care

• You receive care from a Medicare-certified home health provider

When these conditions are met, Medicare Part A typically covers in-home physical therapy at no cost to the patient.

Medicare Part B Coverage for In-Home Physical Therapy

Medicare Part B (Outpatient) May Cover In-Home Physical Therapy When:

• You are not homebound

• A doctor determines physical therapy is medically necessary

• Physical therapy is provided as an outpatient service, even if it takes place in your home

In this case, Medicare Part B generally covers physical therapy with 20% coinsurance after the deductible. What Does “Homebound” Actually Mean? (This Confuses Everyone)

The most common question I get is:

“I can leave my house sometimes… does that mean I don’t qualify?”

No. You can still qualify even if you leave home occasionally.

Here’s Medicare’s actual definition:

Medicare’s Homebound Rule:

You're considered homebound if leaving your home requires a considerable and taxing effort.

You DO qualify if:

• You need a walker, cane, wheelchair, or crutches to leave home

• You need another person’s assistance to get out safely

• Leaving home causes significant fatigue, weakness, shortness of breath, or pain

• You have severe anxiety or fear of falling

• You only leave home for medical appointments, religious services, or rare errands

You DO NOT qualify if:

• You regularly drive yourself places

• You leave home frequently without assistance

• You could reasonably attend outpatient PT without major difficulty

Real-World Medicare In-Home PT Coverage Examples

Mrs. Johnson —Qualifies

She uses a walker indoors and becomes exhausted leaving the house. She only leaves for doctor appointments once a week. She is homebound.

Mr. Thompson —Qualifies

Recovering from hip replacement. His daughter could drive him to a clinic, but the trip is painful and risky. He is temporarily homebound.

Mrs. Chen —Does NOT qualify

Drives herself to church and lunch weekly. Mild balance issues but not homebound. She should attend outpatient PT.

The Key Question to Ask Yourself

“Would getting to a physical therapy clinic be difficult, exhausting, or unsafe for me right now?”

If yes—you're likely homebound.

Still not sure? Call us at (864) 528-6402 and we’ll help you figure it out in 5 minutes.

Conditions Medicare Covers for In-Home Physical Therapy

Medicare covers in-home physical therapy services when it is medically necessary.

Common Covered Conditions

Post-Surgical Recovery

• Hip/knee replacement

• Spinal surgery

• Shoulder surgery

• Fracture recovery

Fall Risk & Balance Problems

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury among older adults, and many are preventable with proper balance training and home safety strategies.

• History of falls

• Significant balance impairment

• Weakness affecting mobility

Chronic Conditions

• Arthritis

• COPD with mobility issues

• Parkinson’s

• Stroke recovery

• General deconditioning

Pain & Functional Limitations

• Chronic back or neck pain

• Difficulty walking or standing

• Trouble performing daily activities

Post-Hospitalization

• Recent discharge

• Preventing readmission

• Recovery support at home

Medicare WILL NOT cover:

• Therapy for general wellness or fitness

• Maintenance-only therapy

• Therapy you could safely get in a clinic

• Non-homebound patients

• Services not provided by a licensed PT

How Do I Get My Doctor to Order In-Home PT?

You need a physician’s prescription for Medicare to cover in-home PT.

Three Simple Ways:

Option 1: Your Doctor Orders It Automatically

Common after surgeries, fractures, or hospitalizations.

Option 2: You Ask Your Doctor

Call your doctor and say:

“I’m having difficulty with [walking/balance/pain/fall risk] and I can’t safely get to a clinic. Can the doctor evaluate me for home health physical therapy?”

Option 3: We Coordinate Everything For You

This is the easiest for most patients.

Call us first → we determine if you qualify → with your permission, we contact your doctor and request the order.

This is normal. We do it every day.

Call us at (864) 528-6402 and we’ll walk you through it.

What Does Medicare Actually Pay? (Real Costs)

Let’s talk dollars.

2026 Part B Deductible:

Medicare Part B costs can change each year. In 2026, patients are generally responsible for meeting the annual Part B deductible, after which Medicare typically covers 80% of approved physical therapy services, with the remaining 20% as coinsurance.

Medicare Part B Pays:

80% of the Medicare-approved amount

You Pay:

20% coinsurance (after your deductible)

Your Out-of-Pocket Cost Per Visit:

Typically $15–35 depending on:

• Services provided

• Your region

• Supplemental insurance

• Medicare Advantage plan details

If You Have a Medigap Plan

Plan G → Most common

You pay: $0 per visit

Plan N

You pay: $0–$20 per visit

Plan F

You pay: $0
(Covers deductible too—only available if enrolled before 2020.)

If You Have Medicare Advantage

Coverage varies by plan:

• Copays may be $0–$40 per visit

• Some plans require prior authorization

• Must use in-network providers

We verify everything for you.

Sample Cost Breakdown (Traditional Medicare, No Medigap)

18 visits over 6 weeks:
Medicare-approved amount: ~$120 per visit
Medicare pays: ~$96
You pay: ~$24

Total cost to you:
$432 for the entire 6 weeks

With Medigap Plan G:$0

How Many Visits Does Medicare Cover?

Medicare doesn’t set a specific visit limit.

Coverage continues as long as:

• You’re making measurable progress

• A skilled PT is required

• You remain homebound

• Your doctor continues to certify need

Typical timeframes:

• Post-surgical: 6–12 weeks

• Fall prevention: 4–8 weeks

• Chronic conditions: 6–10 weeks

If you need more therapy later?
You can have multiple episodes per year.

Does Medicare Cover the Initial Evaluation?

Yes.
Same cost share as regular visits (20% unless you have Medigap).

What About the FREE 30-Minute Safety Check?

This is NOT billed to Medicare.
It’s a courtesy service we provide to help you determine if:

• You need PT

• You’re homebound

• Medicare would cover your care

No cost. No pressure.

What Medicare Does NOT Cover

• Home modifications (grab bars, ramps, shower chairs)

• Maintenance-only therapy

• Non-homebound patients

• Wellness-only therapy

• Services by unlicensed providers

How to Get Started: Step-by-Step

Step 1: Determine If You Qualify

Call us—we’ll tell you in 5 minutes.

Step 2: Get a Doctor’s Order

We can coordinate this for you.

Step 3: We Verify Your Medicare Coverage

You’ll know your exact cost before we begin.

Step 4: Schedule Your Evaluation

A licensed PT comes to your home.

Step 5: Treatment Plan Created & Approved

Step 6: Begin Treatment

Step 7: Discharge With Home Program

Common Questions

Q: “Do I need prior authorization?”

A: Traditional Medicare: No
Medicare Advantage: Often yes — we handle it

Q: “Can I switch from clinic PT to in-home PT?”

A: Yes, if your condition changes and you become homebound.

Q: “Will I get surprise bills?”

A: No. We verify everything up front.

Q: “Can I use Medicare if I’m under 65 with a disability?”

A: Yes — same rules apply.

Medicare Advantage vs Traditional Medicare

Traditional Medicare (Part B)

Pros:

• No networks

• No prior authorizations

• Straightforward rules

Cons:

• 20% coinsurance unless you have Medigap

Medicare Advantage

Pros:

• Often low copays

Cons:

• Networks

• Authorizations

• Varying coverage rules

Traditional Medicare + Medigap Plan G = easiest, lowest cost.

What Makes Southern Steps Different

• We handle all Medicare paperwork

• We verify coverage before starting

• We are transparent about costs

• We don’t push unnecessary visits

• We advocate for you

• We’ve worked with Medicare for 20+ years

Special Situations

Veterans: You may choose VA or Medicare coverage.
Dual eligible (Medicare + Medicaid):Usually $0 out-of-pocket.
Skilled nursing facility: Different rules (Medicare Part A).

Red Flags to Watch Out For

Be cautious if another company says:

🚩 “Medicare covers unlimited visits”
🚩 “We’ll get the doctor’s order later”
🚩 “Don’t worry, Medicare covers everything”
🚩 Vague answers about costs
🚩 “Just sign here”

Transparency matters.

Your Next Steps

Option 1: Start With a FREE 30-Minute Safety Check

We come to your home and assess:

• Fall risks

• Mobility

• Whether you likely qualify for Medicare-covered PT

Call: (864) 528-6402

Option 2: Call With Questions

Quick 5–10 minute conversation.
No pressure.

Option 3: Talk to Your Doctor

Request an order for:
Southern Steps In-Home Physical Therapy

Final Thoughts: Don’t Let Medicare Confusion Stop You

If you’re struggling with walking, balance, pain, mobility, or recovering from surgery—and getting to a clinic is difficult—Medicare likely covers in-home PT.

The rules are complicated.
But that’s our job, not yours.

Call us. We’ll figure out the Medicare part in minutes and give you straight answers.

📞(864) 528-6402
📧[email protected]

2026 Medicare Update:

For 2026, Medicare updated home health payment rules at the federal level. These changes affect how providers are reimbursed but do not change patient eligibility or coverage rules for in-home physical therapy. Medicare beneficiaries who qualify can still receive skilled physical therapy in the home when medically necessary.

Related Medicare & In-Home Physical Therapy Resources

If you’re trying to understand Medicare coverage or decide whether in-home physical therapy is right for you or a loved one, these resources may help:

• In-Home Physical Therapy in Upstate South Carolina: What to Expect
  Learn how in-home physical therapy works, who it’s for, and how seniors across Greenville and the Upstate benefit from receiving care at home.

• Fall Prevention Physical Therapy at Home: How Seniors Stay Independent
  Discover how Medicare-covered physical therapy can reduce fall risk, improve balance, and help seniors remain safe in their own homes.

• Home Physical Therapy Services in Greenville & Upstate South Carolina
  Explore Southern Steps’ Medicare-covered in-home physical therapy services and see which areas of Upstate South Carolina we serve.

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  Southern Steps In-Home Physical Therapy
  Safe, trusted, Medicare-covered care — proudly serving Greenville and surrounding Upstate South Carolina communities.