What is it? 

Outpatient rehabilitation is a program of rehabilitation therapy in which patients travel to a clinic, hospital, or other facility for therapy.  When patients are referred to outpatient rehabilitation programs, it indicates their doctors are confident they will be able to complete a rehabilitation course on an outpatient basis.

Outpatient rehabilitation programs are dedicated to maintaining, improving, or restoring physical strength, mobility, range of motion, function, and cognition to the maximum extent possible. Typically, outpatient rehabilitation helps people achieve greater independence after an illness, injury or surgery.

This form of rehabilitation requires a commitment from the patient and his or her caregivers, if applicable. Patients may need transport to rehab, along with support from friends, family, and employers who are willing to make accommodations for rehabilitation appointments.

How does the program address rehabilitation needs?

The program addresses impairments, activity limitations, and participation restrictions resulting from surgery, injury or illness.   It does so through therapy, mutually agreed upon goals, and education individually tailored to the needs of each individual.  The program is designed to help patients build on the skills needed to be safe and independent, minimize or eliminate pain, and learn skills to prevent reinjury or other complications.

How much therapy does one get in an Outpatient Rehabilitation Program?

The number of sessions required per week varies, depending on the situation. Most people attend outpatient rehab sessions one to three times a week, with the number of sessions being scaled back as the patient’s condition improves. Eventually, the patient may not require outpatient rehab at all.

Will my insurance pay for Outpatient Rehabilitation?


If the below requirements are met, Medicare should pay for therapy.  This would be true whether needed on a temporary basis to restore function, or on an ongoing basis to prevent a decline in function.

Medicare will cover outpatient physical, occupational, and speech pathology services if:

  • Therapy is necessary for you
  • Therapy  is considered a safe and effective treatment for you
  • If you need the skills of  a trained therapist to provide or oversee your treatment plan
  • Therapy is performed or directed by a therapist
  • The treatment is established by a doctor and/or therapist before care is provided
  • Your doctor or therapist regularly reviews the plan of treatment and revises it as appropriate

In 2015, Medicare will cover up to $1,940 for physical and speech therapy combined, and an additional $1,940 for occupational therapy. If you are approaching these limits and your doctor or therapist feels you need more therapy, they will need to tell Medicare by documenting their argument for further services being medically necessary for you to continue. With proper documentation, Medicare may cover additional therapy. If they do not, your therapist should be able to guide you on the next steps.


Many commercial or private insurance plans cover therapy services but there may be certain conditions or limitations to their coverage.  Call your insurance company to find out what services your plan covers.  If you have a second insurance plan  (or if another person in your household has insurance), check with those plans as well. Here are some questions to ask:

    • Does my plan provide coverage for outpatient (physical / occupational / speech)  therapy?
    • How many visits are allowed? The patient and therapist should work together to track the number of visits completed to avoid going over the limit and accruing higher out-of-pocket costs.
    • Are there any exclusions or limitations to therapy coverage?  For example:
      • Some payers (Tricare, for example) may require a new physician referral every 12 months for therapy services
      • Some payers (many Humana plans, for example) will cover an initial therapy evaluation but will not cover ongoing treatment services until they have reviewed a written plan of care and authorized a specified number of visits
    • Ask about out-of-pocket costs such as co-payments (due at each visit) for each therapy service, any unmet deductibles, and co-insurance.

Insurance companies can deny payment if they do not think the services are medically necessary.  A quote of benefits from your insurance carrier does not guarantee coverage. The patient may become responsible for payment if the insurance plan denies coverage.

If you require assistance contacting your insurance company or understanding your plan, please contact us at 208-367-6810. You will be provided with a document describing your insurance benefits.