You're a few weeks into physical therapy after a knee replacement, the bills keep coming, and you're bracing for the day Medicare says you've hit your limit. There isn't one. There's no hard limit on Medicare physical therapy, and no annual dollar cap on the medically necessary care you need. Medicare no longer caps outpatient therapy, so as long as your therapist documents that it still helps, your coverage keeps going.

In This Guide

So Is There a Limit on Medicare Physical Therapy?

The short answer? No. There's no annual dollar limit and no cap on the number of visits for medically necessary outpatient physical therapy. Medicare's own physical therapy coverage page says it plainly: there's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.

That surprises a lot of people, because for years there really was a hard cap. Medicare used to limit how much outpatient therapy it would pay for each year, and once you hit that dollar figure, you were on your own. That cap is gone now.

What sits in its place isn't a limit at all. It's a threshold, and it mostly matters to your therapist's billing office, not to you. So let's look at how it actually works.

If There's No Limit on Medicare Physical Therapy, What's the KX Threshold?

Instead of a hard cap, Medicare Part B now uses an annual "KX modifier threshold." Think of it as a dollar amount that, once your therapy costs cross it, asks your provider to confirm you still genuinely need the care.

For 2026, that threshold is $2,480 for physical therapy (PT) and speech-language pathology (SLP) combined, plus a separate $2,480 for occupational therapy (OT). Those amounts count the Medicare-approved charges for your covered therapy across the calendar year, and they reset every January.

So what happens when you cross it? Your therapist simply adds the KX modifier to the claim. That modifier is their way of telling Medicare, in effect, "yes, this therapy is still medically necessary." Coverage then continues above the threshold exactly as it did below it. You don't file anything, you don't apply for an extension, and nothing about your care changes.

What You Actually Pay

Crossing the threshold changes none of your costs. You pay for outpatient therapy the same way you pay for most other Part B services.

After you've met the annual Part B deductible, which is $283 in 2026, you pay 20% of the Medicare-approved amount for your therapy, and Medicare pays the other 80%., That 20% is the same whether it's your first visit of the year or your fortieth, above the KX threshold or below it. For the fuller picture of premiums and deductibles, see how much Medicare costs.

Two things can lower that 20% for you. If you carry a Medigap (Medicare Supplement) policy, it may cover part or all of that coinsurance, depending on the plan letter you have. And if you're in a Medicare Advantage plan instead of Original Medicare, your copays and any prior-approval rules are set by the plan rather than the standard 20%, so check your plan documents or call the number on your card.

Does This Apply to Occupational and Speech Therapy?

Yes, with one wrinkle in how the threshold is counted. Occupational therapy gets its own separate $2,480 threshold in 2026. Physical therapy and speech-language pathology, by contrast, share a single combined $2,480 threshold between them.

Why does that matter? If you're getting both physical and speech therapy in the same year, they draw down the same threshold together, so you'll reach the KX point sooner than if you were getting just one. Occupational therapy is tracked on its own, so it doesn't count against your PT and speech total. The bottom line is the same for all three, though: crossing the threshold doesn't stop your coverage, and none of the three has a hard dollar cap. If you want the fuller rundown of how each type is covered, our guide to Medicare therapy coverage walks through PT, OT, and SLP in detail.

Frequently Asked Questions

How many physical therapy sessions will Medicare pay for?

There's no fixed number. Medicare covers as many sessions as are medically necessary, judged by your therapist and documented in your record. The threshold is a dollar figure, not a session count, so there's no "you get 20 visits and you're done" rule.

What is the KX modifier?

It's a short code your therapist adds to a Medicare claim once your therapy costs pass the annual threshold. It tells Medicare the services are still medically necessary. You don't request it or file anything yourself; it happens on the provider's side, and your coverage carries on.

Does the Medicare therapy cap still exist?

No. The old hard therapy cap is gone, and Medicare no longer stops paying after a set dollar amount. If you read that Medicare cuts you off at a certain figure, that's the outdated rule. What exists now is the KX threshold, which is a documentation checkpoint, not a payment ceiling.

Learn More

MedicareMedicare Therapy Coverage: PT, OT & SLP ExplainedMedicare therapy coverage in 2026: the $283 Part B deductible, 20% coinsurance, the $2,480 KX modifier threshold, and how to keep claims paying above it. MedicareHow Much Does Medicare Cost in 2026?How much does Medicare cost in 2026? Part A, B, C, and D premiums, deductibles, and coinsurance, plus IRMAA and ways to lower your Medicare costs. MedicareOriginal Medicare vs. Medicare Advantage: How to ChooseCompare original Medicare vs Medicare Advantage on cost, networks, the $9,250 cap, and switching back. A neutral 2026 side-by-side to help you choose. MedicareDoes Medicare Require You to Improve to Keep Covering Therapy?No, Medicare doesn't require you to be improving to cover skilled therapy or nursing. The Jimmo settlement means maintenance care counts too. Here's how.

Find personalized help understanding what a course of Medicare physical therapy will actually cost at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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