Is Pelvic Floor Therapy Covered by Insurance? 

When the pelvic floor is functioning well, we are able to go to the bathroom when we need to, avoid going when we shouldn’t, and maintain our sexual health. 

Common dysfunctions of the pelvic floor include urine or stool leakage (incontinence), difficulty with bathroom usage (voiding), sexual pain or dysfunction, and pelvic organ prolapse. Both women and men can experience dysfunction with their pelvic floor. 

Pelvic floor physical therapy (PFPT) is an effective treatment for these issues that uses a wide range of physical therapy techniques.

But is pelvic floor therapy covered by insurance? 

Insurance usually covers pelvic floor physical therapy, especially when deemed medically necessary. Major insurance networks such as Medicare, Blue Cross Blue Shield, Cigna, Aetna, United Healthcare, and Humana typically cover it. For Medicaid users, coverage varies by state. 

Some insurance companies require a referral from a physician or pre-authorization from a medical provider. Even with insurance coverage, you may have out-of-pocket costs, depending on the details of your policy. 

This guide outlines which insurance companies cover PFPT, the conditions that must be met, and other essential details to ensure you receive the care you need.  

Which insurance carriers cover pelvic floor therapy?

Many insurance plans cover pelvic floor therapy, although it varies by policy and individual circumstances. In some states, physical therapy is direct access. This means that you don’t need a referral from a physician. 

Does Blue Cross Blue Shield cover pelvic floor therapy?

Blue Cross Blue Shield typically covers pelvic floor PT under its outpatient PT benefits. If you have general PT coverage, you are likely covered. BCBS requires a $25-$35 copayment for PT services.

Does Medicare cover pelvic floor therapy?

Medicare covers (PFPT) if medically necessary under Medicare Part B. Medicare Part B refers to Medicare’s outpatient PT coverage. Keep in mind that Medicare has a yearly cap of $1,900 for outpatient PT. Certain treatments, like electric stimulation, bladder pacers, and retraining mechanisms for urinary incontinence, might only be covered after trying other therapies first. 

Does Medicaid cover pelvic floor therapy?

Medicaid coverage for PT services varies by state. If you live where Medicaid covers outpatient PT services, PFPT may be included. Copayments also vary by state. 

Does Cigna cover pelvic floor therapy?

Cigna typically covers PFPT. Coverage varies by plan and medical necessity. With any plan, a doctor’s order signifying medical necessity will increase your chances of being covered. Find out if you need a pre-authorization before you see a therapist. 

Does Aetna cover pelvic floor therapy?

Aetna will cover PFTP when deemed medically necessary. Coverage can vary by condition, and pre-authorization may be required. 

Does UnitedHealthcare cover pelvic floor therapy?

United Healthcare generally covers PFPT under its PT benefits, but pre-authorization may be required.

Does Humana cover pelvic floor therapy?

Humana covers PFPT if deemed medically necessary, and pre-authorization may be required. 

How to tell if your health insurance covers pelvic floor therapy?

These steps will help you determine your coverage. Insurance providers and plans vary widely, so it’s important to research your specific policy. 

Here’s a step-by-step guide:

1. Review your insurance policy. Most insurance companies explicitly state their coverage details. For example, you can search online for “Medicare pelvic floor physical therapy coverage.” 
2. Contact your insurance provider. Although it can be challenging to reach an actual human, calling or emailing your insurance provider is a good way to get detailed information about your coverage. 
3. Discuss medical necessity. This is important. The term “medical necessity” refers to how necessary the treatment of your condition is deemed. Insurance companies decide what is medically necessary, so finding a qualified physical therapist or referring provider who understands thorough documentation of your sessions is crucial for approval.
4. Check if pre-authorization is required. Some insurance companies require written documentation in order to approve coverage for PT services. This may require an additional appointment or virtual visit with your provider.
5. Ask if you need a referral from a doctor. In some states, physical therapy is direct access. This means you do not need a referral from your doctor. However, some states still require a doctor’s referral. 
6. Verify in-network providers. When browsing for a physical therapist, check with them or your insurance provider to ensure that they accept your insurance plan.
7. Understand what your out-of-pocket costs will be. PFPT may not be fully covered by your insurance, and copays may apply even if it is covered. You can learn more about the costs of pelvic floor therapy both with insurance and out-of-pocket here.
8. Check state regulations. Each state has different rules and regulations that govern physical therapy and insurance reimbursement. 
9. Check session limits. Most insurance plans will only cover a certain number of PT visits. After this, they may need updated documentation from your medical team indicating further medical necessity, or they will stop covering services. 
10. Explore alternative options. Due to the complexities of working with insurance providers, some pelvic floor physical therapists operate on a cash-based business model. While potentially more expensive per session, cash physical therapists typically spend more time with their clients and are not constrained by insurance limitations.