Most health insurance plans cap physical therapy at a set number of visits per year, but those limits aren’t always final. You can often get additional visits approved by working with your therapist to document medical necessity, requesting re-authorization before your visits run out, and appealing any denials. The process takes some coordination, but the system is designed to allow exceptions when the clinical need is clear.
Know Your Plan’s Visit Limits
The first step is understanding exactly what your plan covers. Most commercial insurance plans allow somewhere between 20 and 60 physical therapy visits per year, though some cap visits much lower. Your plan documents (the Summary of Benefits and Coverage) will list the specific number. If you have Medicare, there’s no hard visit cap, but there is a spending threshold. For 2026, Medicare flags claims for review once physical therapy charges exceed $2,480 per calendar year. Above $3,000, claims enter a targeted medical review process where each visit gets extra scrutiny.
Knowing your limit matters because the strategy for getting more visits depends on when you act. If you’re approaching your cap, your therapist can begin preparing documentation before you hit the wall. If you’ve already been denied, you shift into appeal mode. Either way, the sooner you start, the better.
Medical Necessity Is the Key
Insurance companies approve additional visits for one reason: medical necessity. This means your records need to show that you’re making meaningful, measurable progress and that stopping therapy now would result in a decline or prevent you from reaching functional goals. Vague notes about “feeling better” won’t cut it.
Insurers look for comparable objective measurements taken at the start of treatment, during treatment, and at each progress check. For example, if your therapist measured your shoulder range of motion at 90 degrees initially and it’s now at 140 degrees with a goal of 160, that tells a clear story. What doesn’t work is mixing measurement types, like comparing a muscle strength score to the number of exercise repetitions you can do. Insurers will deny claims when the data points aren’t directly comparable.
Your therapist is required to complete progress reports at minimum every 10 treatment sessions. These reports are the backbone of any request for more visits. If your therapist hasn’t been updating your records consistently, ask them to make sure everything is current before submitting for additional authorization.
How Re-Authorization Works
When your approved visits are running low, your therapist’s office submits a new prior authorization request to your insurer. With most plans, the treating therapist can submit this directly. The timing matters: you can typically submit the request up to 14 days before you need the next visit, so don’t wait until your last session.
The documentation your insurer expects with a re-authorization request generally includes:
- A signed physician referral obtained at the time of your original evaluation
- Your current evaluation or plan of care (if it was completed within the past six months, a new evaluation usually isn’t required)
- Your most recent progress report or daily treatment notes showing measurable improvement
Most insurers process a complete request within 14 calendar days, though many review it within three days if all the paperwork is in order. The word “complete” is doing heavy lifting there. Missing documents are the most common reason for delays, so confirm with your therapist’s office that everything has been submitted before the clock starts.
Ask Your Therapist for a Letter of Medical Necessity
A Letter of Medical Necessity is a written explanation from your treating physician or therapist that spells out exactly why you need continued care. This letter can be the difference between approval and denial, especially when you’ve exceeded your plan’s standard visit count.
An effective letter includes several specific elements. It should describe the services being requested, including the exact number of visits, frequency, and duration. It needs a medical explanation linking your condition to the therapy, based on a recent physical exam (ideally within the past 60 days for ongoing services). Most importantly, it must explain how continued therapy will lead to measurable improvement in specific daily activities within a reasonable timeframe.
The letter should also address why stopping therapy now isn’t appropriate. If you’ve made progress but haven’t yet reached the functional level needed to return to work, care for yourself independently, or avoid re-injury, that reasoning belongs in the letter. Insurers want to see that the requested visits aren’t maintenance (which many plans don’t cover) but are actively driving you toward a defined goal.
Request a Peer-to-Peer Review
If your request for more visits is denied, your therapist or referring physician can often request a peer-to-peer review. This is a phone call between your treating clinician and the insurance company’s medical reviewer. It gives your provider a chance to explain your case directly, answer questions about your progress, and advocate for continued treatment in a way that paperwork alone sometimes can’t accomplish.
Not every insurer offers this step, and it’s not always labeled the same way, but it’s worth asking about. Your therapist should come prepared with your objective measurements, your functional goals, and a clear explanation of what will happen if therapy stops. This conversation often happens before a formal denial becomes final, so timing is important.
How to Appeal a Denial
If your insurer denies additional visits, you have the legal right to appeal. The process has two levels, and knowing both gives you more leverage than most people realize.
Internal Appeal
Your first option is an internal appeal, where you ask your insurance company to conduct a full review of its own decision. You’ll submit a written appeal along with any supporting documentation: your therapist’s progress notes, the letter of medical necessity, and any additional clinical evidence. If your situation is urgent (for example, you’re in the middle of post-surgical rehab and a gap in therapy could cause complications), your insurer is required to expedite the review.
External Review
If the internal appeal is denied, you have the right to an external review. This sends your case to an independent third party that has no connection to your insurance company. The external reviewer examines your medical records and makes a binding decision. This is a powerful tool because the insurance company no longer gets the final say. Many people don’t pursue this step because they don’t know it exists, but it’s guaranteed under the Affordable Care Act for most health plans.
Practical Steps You Can Take Now
While much of this process runs through your therapist’s office, there are things you can do to improve your chances. Keep copies of every progress report your therapist writes. Ask your therapist at each session how your objective measurements are trending, and whether the documentation would support a request for more visits. If you’re nearing your visit cap, raise the issue with your therapist several sessions early so there’s time to prepare a re-authorization or letter of medical necessity without a gap in your care.
Track your own functional progress in concrete terms. Can you walk farther than when you started? Can you climb stairs you couldn’t before? Can you get dressed without assistance? These real-world improvements matter, and being able to describe them clearly can strengthen your case if you need to write a personal statement as part of an appeal.
If your employer offers multiple insurance plans during open enrollment, it’s also worth checking whether a different plan option has higher therapy visit limits. Some plans offer 60 or more visits per year, while others cap at 20. If you know you’ll need ongoing rehabilitation, choosing a plan with a higher therapy allowance during enrollment can save you the authorization battle entirely.