Physical Therapy Visits Denied by Insurance
What can I do if insurance denies physical therapy?
A physical therapy denial may involve a visit limit, missing authorization, a billing issue, or a dispute about continued need. Identify the reason and the dates affected before assuming all remaining therapy is excluded.
Get help with my bill →Review the benefit and authorization history
Ask how the plan counts visits, whether limits combine different therapies, and whether approvals apply to specific dates or units. Distinguish visits used from visits authorized. A benefit limit and a medical-necessity denial require different arguments.
Ask the therapist for the relevant record
For a clinical denial, ask for the plan of care, progress notes, functional findings, and the treating team’s explanation of why skilled therapy remains needed. The evidence should address the plan’s stated criteria. Do not add progress or symptoms that the records do not support.
Check the claim details
Ask billing to verify service codes, units, dates, provider information, and authorization references. If the submitted record is inaccurate, ask for correction. If it is accurate and the plan is denying coverage, obtain the formal appeal instructions.
Do not apply commercial visit caps to Original Medicare
Medicare.gov states there is no annual limit on payment for medically necessary outpatient therapy under its Original Medicare rules. This does not mean every visit is covered without conditions. Medicare Advantage procedures and any applicable noncoverage notices need their own review.
Address continuity and appeal timing
Discuss the clinical effect of delay with the therapist and ordering clinician. Ask about expedited review or continuation rules when relevant. Follow any notice about ending ongoing services promptly. Ask the billing office whether it can hold disputed charges, and confirm what future visits would cost while the appeal is pending.
Which plan rules apply?
For commercial coverage, check the policy and state-specific instructions. A self-funded employer plan can use different oversight and appeal rules even when an insurer administers claims. Medicare and Medicaid use program-specific notices and review routes. Confirm the applicable deadline, whether a correction counts as an appeal, and where to escalate; do not substitute a deadline from a different plan.
Sources and further help
These sources provide general guidance. For a deadline or requirement that applies to you, follow your plan’s notice or the appropriate program’s current instructions.
- Medicare.gov: Outpatient physical therapy coverage ↗
- Medicare: Therapy coverage fact sheet ↗
- U.S. Department of Labor: Filing a claim for your health benefits ↗
Insurer websites may ask you to select your state or sign in. If a page will not open, use the member services number on your insurance card and ask for the current appeal instructions for your plan.