Insurance and referrals
Does Medicare cover pelvic floor physical therapy?
Yes. Medicare Part B covers medically necessary physical therapy, including pelvic floor physical therapy, with no referral required and no annual visit cap, though a therapy threshold triggers extra documentation. Telehealth physical therapy is covered by Medicare. EMS Therapy is enrolled with traditional Medicare and sees Medicare patients in Florida by video and in-home in Miami-Dade.
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.
Incontinence, prolapse, pelvic pain, and post-surgical recovery are common covered diagnoses for Medicare beneficiaries, and pelvic floor physical therapy is the guideline-recommended first-line treatment for the first two.
EMS Therapy verifies Medicare and supplement coverage before the first visit. Florida 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
How much does pelvic floor therapy cost with Medicare?
After the Part B deductible ($283 in 2026), Medicare pays 80 percent of its approved amount and the patient pays 20 percent, which for a pelvic floor physical therapy visit is usually in the range of $15 to $30. A Medigap supplement typically covers that 20 percent, so many patients pay nothing per visit.
Do I need a referral for pelvic floor therapy with Medicare?
No referral is needed to start. Medicare does require the therapist's plan of care to be signed by a physician or nurse practitioner within 30 days of the evaluation; EMS Therapy sends it to the patient's doctor and handles the signature.
Is there a limit on how many visits Medicare covers?
There is no annual visit cap. Above a yearly therapy threshold (about $2,480 in 2026, physical therapy and speech therapy combined) the therapist adds documentation of medical necessity and care continues. Most pelvic floor plans of care finish well under that amount.
Does Medicare cover pelvic floor therapy by telehealth?
Yes. Medicare currently covers physical therapy delivered by video when the therapist is enrolled with Medicare and licensed in the patient's state. EMS Therapy sees Medicare patients by video anywhere in Florida and Maryland, and in person at home in Miami-Dade County.
Does Medicare Advantage cover pelvic floor therapy?
Yes. Medicare Advantage plans must cover the same physical therapy benefit as traditional Medicare, but each plan has its own network, copay and sometimes prior authorization. EMS Therapy checks the specific plan before the first visit.
Which pelvic conditions does Medicare cover physical therapy for?
Urinary incontinence, overactive bladder, pelvic organ prolapse, pelvic pain, constipation, recovery after pelvic or prostate surgery, and bowel leakage are all covered diagnoses when physical therapy is medically necessary, and pelvic floor physical therapy is the guideline-recommended first treatment for incontinence and prolapse.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Florida.
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.