Physical therapy was denied because I am not making progress. Can I appeal?
Yes. A plateau can still require skilled therapy when therapy is needed to maintain function, prevent deterioration, teach safe movement, or treat a condition that cannot be managed by a home exercise handout. Appeal with objective measures, therapist notes, functional goals, and a clinician statement explaining skilled need.
What to do, in order
- Step 1
Get the therapy policy
Ask what rule the plan used: visit limit, progress requirement, medical necessity, or maintenance exclusion.
- Step 2
Use objective measures
Range of motion, strength, gait, balance scores, pain scores, ADL limitations, and safety risks are stronger than general statements.
- Step 3
Explain why skilled therapy is still needed
The therapist should say what skilled interventions are being provided and why a home program alone is not safe or sufficient.
- Step 4
Separate visit-limit and medical-necessity issues
If the benefit limit is exhausted, the appeal is different from a medical-necessity denial before the limit.
The deadline that applies
At least 180 days to appeal on employer and ACA plans. Urgent review may apply if stopping therapy risks serious decline, but many post-service PT claims use the standard clock.
Calculate your date →Documents to gather
- PT denial or EOB
- Plan therapy policy
- Initial evaluation and progress notes
- Objective measures over time
- Therapist letter
Go deeper
Related questions
Does maintenance therapy ever count?
Sometimes, when skilled therapy is needed to safely maintain function or prevent deterioration. The plan policy and payer type matter.
What if I hit the visit limit?
Ask whether exceptions are available. A hard benefit limit is harder than a medical-necessity denial.
Should the therapist or doctor write the letter?
Ideally both: the therapist explains skilled interventions, and the physician supports medical necessity.
Sources
Share your denial and ask our team about appeal preparation and filing support. $0 upfront. Review the fee and terms before deciding. Apellica is not a law firm and cannot guarantee an outcome.
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