FROM MY PT SCHOOL NOTES · HEALTHCARE SYSTEMS · UNIT 1 · CHAPTER 04
Medicare: Parts A, B, C and D
04 Medicare: Parts A, B, C and D Is the patient’s therapy governed by Original Medicare or a private Medicare Advantage plan?
Core ideas from class
- Part A generally relates to inpatient hospital and certain facility/home health benefits; Part B includes physician and outpatient services; Part C is Medicare Advantage; Part D concerns drug coverage.
- Eligibility does not automatically guarantee coverage of every rehabilitation service. Setting, benefit, skilled need and plan-specific conditions matter.
- Original Medicare no longer has a hard annual outpatient therapy cap. Above the annual KX threshold, covered medically necessary care may continue when claims and documentation satisfy the applicable rules.
Think like a PT
A Medicare beneficiary says, “I used all my therapy.” Ask which plan, what threshold or authorization is involved, and whether continued skilled care is medically justified.
Remember
Separate benefit structure from utilization controls and from clinical necessity.
2026 policy reference: See the CMS Therapy Services page for current payment and documentation rules, including 2026 KX thresholds. Coverage policy is not identical across payer, setting or state.
From my class sources: 6 Medicare.pdf. These are personal school notes with additional editorial context, not current legal advice, payer guidance, a coding manual, or a guaranteed reimbursement rule. Verify any current policy directly.
