Paying for Pelvic Floor Physical Therapy: Medicare and Insurance Questions

If you leak when you cough or laugh, or feel heaviness in your pelvis, a pelvic floor physical therapist can teach you to find and strengthen the right muscles. The UK’s NICE¹ guideline recommends at least three months of supervised pelvic floor muscle training as a first treatment for stress or mixed incontinence.¹ Cost is a common reason women skip it. Here is how coverage works.

Original Medicare

Medicare Part B covers medically necessary outpatient physical therapy. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.²

Therapy can come from physical therapists, and sometimes from doctors, nurse practitioners or physician assistants. Settings include private therapy practices, medical offices and hospital outpatient departments.² Ask whether the therapist has pelvic floor training, since not every physical therapist treats bladder problems.

If a therapist believes a service isn’t medically necessary, they can only charge you for it if they give you a written notice first, called an Advance Beneficiary Notice of Noncoverage (ABN). They can’t give you an ABN simply because your therapy costs have reached a certain amount.²

If you have a Medicare Advantage plan, the rules may differ. Check with your plan.²

Private insurance

Plans vary widely. Before your first visit, call the number on your card and ask:

1. Is pelvic floor physical therapy covered, and do I need a referral or prior approval?
2. Is this therapist in network?
3. How many visits are covered each year, and do physical therapy visits share a limit with other therapy?
4. What’s my copay or coinsurance per visit, and have I met my deductible?

Write down the date, the name of the person you spoke with and a reference number.

Getting the most from your visits

• Ask for a home program. Most of the work happens between appointments.
• Keep a bladder diary before and during treatment, so you can see change. Our article on bladder diaries explains what to record.
• Give it time. NICE’s¹ recommendation is for at least three months of training.¹

If you’re weighing devices instead, our articles on Kegel trainers and magnetic chairs cover what they can and can’t do.

Free help with Medicare questions

Your State Health Insurance Assistance Program (SHIP) offers free, personalized Medicare counseling. Find yours at shiphelp.org or by calling 1-800-MEDICARE.²

Try: “I leak when I cough and I’d like to try pelvic floor physical therapy. Can you refer me to a therapist who treats bladder problems, and will my plan cover it?”

Laugh, Sneeze, Jump includes an appointment prep sheet. Use it to record your leaks, triggers and coverage details before your first visit.