Insurance and referrals
Does Medicare cover pelvic floor physical therapy in Maryland?
Yes. Medicare Part B covers medically necessary physical therapy, including pelvic floor physical therapy, with no referral required to start and no annual visit cap, though a therapy threshold triggers extra documentation. EMS Therapy is enrolled with traditional Medicare in Maryland and sees Medicare patients anywhere in the state by video.
The details
What to know
Answered by the practice of Dr. Elana Shalem, DPT, pelvic floor and orthopedic physical therapist.
After the Part B deductible, Medicare pays 80 percent of the approved amount and the patient or a Medigap supplement pays 20 percent. Medicare Advantage plans cover the same services but have their own networks, copays and sometimes prior authorization; they are checked individually.
Medicare currently covers physical therapy by video when the therapist is enrolled with Medicare and licensed in Maryland. Incontinence, prolapse, pelvic pain and recovery after surgery are common reasons Medicare beneficiaries see a pelvic floor physical therapist.
EMS Therapy verifies Medicare and supplement coverage before the first visit. Phone 786-273-9151.
How it works
How a virtual visit works
Most of pelvic floor physical therapy is education, breathing and pressure management, movement retraining, and a home program. All of it works on camera. During the evaluation, Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating with breath and movement. An internal examination is not possible by video; if a hands-on assessment would change the plan, she says so and helps the patient find local care.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Questions
Common follow-up questions
What does a Medicare patient in Maryland pay per visit?
After the Part B deductible ($283 in 2026), 20 percent of Medicare's approved amount, usually $15 to $30 for a pelvic floor physical therapy visit. A Medigap supplement typically covers it, so many patients pay nothing per visit.
Do I need a referral for pelvic floor therapy with Medicare in Maryland?
No referral is needed to start. Medicare requires the plan of care to be signed by a physician or nurse practitioner within 30 days of the evaluation; EMS Therapy sends it and handles the signature.
Does Medicare cover pelvic floor therapy by video in Maryland?
Yes. Medicare currently covers physical therapy by video when the therapist is Medicare-enrolled and licensed in Maryland. That matters on the Eastern Shore, in Southern Maryland and in the western counties, where a pelvic floor specialist otherwise means a drive to Baltimore or Washington.
Is there a visit limit?
No annual cap. Above a yearly therapy threshold (about $2,480 in 2026) the therapist documents medical necessity and care continues. Most pelvic floor plans of care finish under that amount.
Does Medicare Advantage cover it in Maryland?
Yes, with the plan's own network, copay and sometimes prior authorization. EMS Therapy checks the specific plan before the first visit.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Maryland.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.