Does Medicare cover outpatient surgery and physical therapy?

Quick Answer

Yes, Medicare covers outpatient surgery and physical therapy under Part B. You typically pay 20% of the Medicare-approved cost after meeting your deductible.

Detailed Explanation

Part B, which is the outpatient side of Medicare, covers a wide range of services you receive without being admitted to a hospital. Outpatient surgery performed at a hospital or ambulatory surgical center is covered. Physical therapy, occupational therapy, and speech-language pathology are covered as well. These have historically had caps on how much Medicare would pay in a year, but Congress permanently removed those caps, so medically necessary therapy is no longer cut off at an arbitrary dollar limit. The standard cost-sharing under Part B is 20% of the Medicare-approved amount, after you meet the annual Part B deductible. That 20% can add up, especially for a surgical procedure. If you have a Medicare Supplement plan, also called Medigap, it will typically cover some or all of that 20%. If you are on a Medicare Advantage plan, your cost-sharing will follow that plan's specific structure, which might be a copay per visit rather than a percentage. One thing to confirm before any procedure is whether the provider accepts Medicare assignment, meaning they agree to Medicare's approved rates. Providers who do not accept assignment can charge you more. Always verify current coverage details with Medicare or your plan directly.

How This Applies in Utah

If you receive care through Intermountain Health or University of Utah Health, both systems accept Medicare. If you are on a Medicare Advantage plan, check that your specific facility and provider are in-network before scheduling a procedure to avoid unexpected costs.

What This Means For You

For you, this means outpatient surgery and physical therapy are covered under Medicare, but you will likely owe a share of the cost, and having a supplement or Advantage plan can significantly reduce what comes out of your pocket.

Disclaimer

‍How Resting Sycamore Advisors Uses CMS Data

Our Commitment to Reliable Medicare Information

At Resting Sycamore Advisors, we work to provide accurate, current, and trustworthy information about Medicare Advantage, Medicare Part D, and Special Needs Plans.

To do that, we use data published by the Centers for Medicare & Medicaid Services (CMS), which is the official source for Medicare plan and enrollment information.

CMS Data Sources We Rely On

Our Medicare plan pages and comparison tools are powered by CMS datasets, including:

  • Medicare Advantage and Part D Landscape Files for annual plan availability and benefit details
  • Plan Benefits Package (PBP) Files for detailed benefit and coverage information
  • Part C and Part D Performance Data for quality ratings and plan performance measures
  • Monthly Enrollment Data for enrollment counts by contract, plan, state, and county

When possible, we link to the original CMS resources so you can review the source material directly.

How Often We Update Our Data

We follow the CMS release schedule and update our website as new data becomes available.

Annual Plan Year Updates (September)

We load new plan year Landscape and PBP files before the Medicare Annual Enrollment Period (October 15 through December 7). We also monitor CMS.gov for updates or revisions and refresh our content when needed.

Mid-Year Updates

We update enrollment and performance data as CMS publishes revised files, which are typically released monthly or quarterly.

Ongoing Maintenance

We routinely monitor CMS announcements for corrections, reissued files, or other changes and update our pages accordingly.

Each plan page includes a Last Accessed date so visitors can see when the source information was most recently reviewed.

How We Prepare CMS Data for Our Website

CMS data can be difficult to read in raw form. To make it easier to use, we format and organize the data for clarity.

This includes:

  • Standardizing plan identifiers such as contract ID, plan ID, and segment
  • Normalizing terminology so common Medicare terms are presented consistently
  • Organizing plan information by state, county, and ZIP code to match how people shop for coverage

All data values come from CMS. We do not change the underlying values beyond formatting, organization, and presentation.

Version Tracking and Transparency

We keep internal records of the CMS dataset versions used on our site.

Major Version History

  • Current Version: CY2025 Medicare Advantage and Part D Landscape Files (v1.0, published October 2025)
  • Prior Version: None. Resting Sycamore Advisors first began publishing structured Medicare plan information in March 2025

If CMS issues corrected or revised files, we update our website to reflect the latest available version.

Important Limitations

Please keep the following in mind:

  • CMS is the official source of truth. For enrollment and coverage decisions, always confirm details with Medicare.gov or 1-800-MEDICARE.
  • Data timing can vary. Enrollment and performance updates may appear on our website a few weeks after CMS publishes changes.
  • Plan details can change. Plan availability, costs, and benefits may change. Always verify current details directly with the plan provider.

Need Help From Official Medicare Resources?

For personalized Medicare assistance, please use these official resources:

  • Medicare.gov Help Center — https://www.medicare.gov
  • 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048
  • State Health Insurance Assistance Program (SHIP) — free local counseling for Medicare beneficiariesIf you want, I can also give you a shorter legal-style version for a footer or /disclaimer page summary.