You do not need a doctor’s referral to start physical therapy under Original Medicare. Medicare PT coverage depends on a different document: the plan of care your physical therapist writes after your evaluation, which your physician, nurse practitioner or physician assistant then signs. Lake Erie Physical Therapy in Buffalo accepts Medicare. We are not providers for Railroad Medicare. If you have a Medicare Advantage plan, it may add its own approval rules. This is how the process works.
Medicare PT coverage, step by step
- Book directly. Medicare has no requirement for a referral or order before therapy begins.
- Evaluation and plan of care. Your physical therapist examines you and writes a plan that lists your goals and how often and how long treatment should last.
- Certification. We send the plan to your physician, nurse practitioner or physician assistant to sign. Medicare expects that signature generally within 30 days of your first treatment, and your evaluation counts as the first treatment.
- Recertification. If you need care past the end of the plan or past 90 days, your provider reviews and signs again. Recertification is required at least every 90 days.
Medicare can deny payment when a plan of care is not certified. It helps to let your doctor’s office know you have started therapy, and to bring their name, phone and fax number to your first visit.
What Part B pays
Medicare Part B helps pay for medically necessary outpatient physical therapy. After you meet the yearly Part B deductible, you generally pay 20% of the Medicare-approved amount. Medicare does not set a fixed number of visits. What matters is that your care stays medically necessary and your plan of care stays current. For a plain explanation of deductibles and coinsurance, see our pricing page.
Medicare Advantage plans and prior authorization
Medicare Advantage plans are run by private insurers. They cover physical therapy but can set their own rules, including provider networks and prior authorization. Independent Health is a local example: for services on or after October 15, 2025, its Medicare plans require prior authorization through Evolent before physical therapy is provided in an office like ours. Bring your Medicare Advantage card to your first visit so the request can go in before treatment. You can also review all the insurance plans we accept.
Railroad Medicare
We are not providers for Railroad Medicare. If your Medicare comes through the Railroad Retirement Board, your Part B claims go to a separate contractor, Palmetto GBA, and we do not bill it. Our self-pay rates are one option, or call us and we will talk through your choices.
What to bring
- Your Medicare or Medicare Advantage card, plus any supplemental or secondary insurance card
- The name, phone and fax number of the doctor, nurse practitioner or physician assistant who will sign your plan of care
- A list of your current medications
- Any imaging reports (MRI, CT, X-ray) or operative reports
Arrive 30 minutes early to complete paperwork, or ask for the digital intake link so you can fill out the forms online first. Read more about your first visit.
When your therapy ends
Once your Medicare-covered care wraps up, our Keep It Going program lets you keep exercising with healthcare professionals on staff. It is an out-of-pocket program that insurance usually does not cover, and it requires a prescription for maintenance exercise, medical clearance to exercise and a signed waiver.
Ready to begin? Call (716) 332-4838 with your Medicare card handy, or request an appointment online. No referral is needed to book.