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On this page14 sections
- Key takeaways
- What is pelvic floor therapy, and who is it for?
- How much does pelvic floor therapy cost?
- Does insurance cover pelvic floor therapy?
- What CPT codes does pelvic floor therapy bill under?
- Do you need a referral for pelvic floor physical therapy?
- Does Medicaid cover pelvic floor therapy after birth?
- Do any states require insurance to cover postpartum pelvic floor therapy?
- Can you use an HSA or FSA for pelvic floor therapy?
- How do you find a pelvic floor physical therapist near you?
- What to ask before your first visit: a checklist
- What should you do before your first visit?
- Questions people ask
- Sources
Key takeaways
- Pelvic floor therapy is billed with the same codes as other physical therapy (an evaluation, then 15-minute treatment units, plus pelvic floor biofeedback codes 90912 and 90913), so it falls under your plan's rehabilitative services benefit, not its maternity benefit.
- Medicare's 2026 national rate is about $98 for a physical therapy evaluation, $28 to $35 for most 15-minute treatment units and about $82 for the first 15 minutes of pelvic floor biofeedback. Private plans and cash prices vary from these figures.
- Physical therapy is an optional Medicaid benefit. In KFF's 2018 survey, 40 states covered it for adults in fee-for-service Medicaid, often with visit caps or prior approval, such as 20 visits a year in Kentucky and 30 a year without prior approval in Ohio.
- Every state and DC allows some form of direct access to a physical therapist without a prescription, according to the APTA, but your insurer or Medicaid program may still require a referral before it pays.
- New York bills A8144 and S4917 would add postpartum pelvic floor therapy to the state's required maternity coverage. As of April 2026 the Assembly bill was still in committee. A 2026 New Hampshire bill on pelvic health therapy coverage was voted down.
Pelvic floor physical therapy after birth is usually covered by health insurance when it's medically necessary, but not as a special postpartum benefit. Plans treat it as ordinary outpatient physical therapy. That means your deductible, your copay or coinsurance, and your plan's yearly physical therapy visit limit all apply, and some plans want a referral or prior approval first.
No federal law, and as far as we could find no state law, requires plans to cover pelvic floor therapy specifically after birth. New York has a bill that would [16]. For a sense of price, Medicare's 2026 national rate is about $98 for a physical therapy evaluation and about $28 to $35 for each 15-minute unit of treatment, which we calculated from the CMS fee schedule file [8]. Cash prices at private clinics are set by each clinic.
This guide covers what the therapy bills as, what it tends to cost, how Medicaid and private plans handle it, and what to ask before your first visit. It isn't medical advice: whether pelvic floor therapy is right for you is a question for your OB-GYN, midwife or primary care clinician.
What is pelvic floor therapy, and who is it for?
Pelvic floor therapy is physical therapy for the muscles that support the bladder, bowel and uterus. It's done by a licensed physical therapist, often one with extra training in pelvic health.
The National Institute of Child Health and Human Development (NICHD) describes pelvic floor muscle training, often called Kegel exercises, as a nonsurgical treatment that may improve symptoms of urinary incontinence and prolapse when done correctly and routinely. Women can do the exercises on their own or with a pelvic floor physical therapist, and therapists sometimes use biofeedback to help a woman learn which muscles to squeeze [2].
Childbirth is one of several factors researchers link to pelvic floor disorders. NICHD notes that the risk may be greater with forceps or vacuum delivery, that in some studies it rises with the number of births, and that a cesarean reduces but doesn't eliminate the risk. It also says the link between pregnancy, childbirth and these disorders remains unclear [3].
The American College of Obstetricians and Gynecologists (ACOG) recommends that postpartum care be an ongoing process rather than a single visit. ACOG advises contact with your obstetric care provider within the first 3 weeks after birth and a comprehensive postpartum visit no later than 12 weeks after birth, covering physical recovery among other areas [1]. That comprehensive visit is a natural time to bring up leaking, pain, pressure or other concerns and to ask whether a referral to physical therapy makes sense. Our after-the-birth checklist lists the other postpartum appointments to schedule.
How much does pelvic floor therapy cost?
There's no national survey of what pelvic floor therapy costs, so the most reliable benchmark is what Medicare pays. Your actual cost depends on whether you're insured, your plan's cost sharing and the clinic's own rates.
Physical therapy is billed in pieces. The first visit is an evaluation. After that, each visit is billed as a set of 15-minute "units" of treatment, with each type of treatment (exercise, hands-on manual therapy, biofeedback and so on) carrying its own code [8][9]. A one-hour visit may be billed as three or four units.
Here's what Medicare paid nationally in 2026 for the codes pelvic health therapists commonly bill. We calculated each figure from the CMS 2026 Physician Fee Schedule relative value file (October release), using the national non-facility amount before regional adjustments [8].
| Code | What it's for | Medicare 2026 national rate |
|---|---|---|
| 97161, 97162, 97163 | Physical therapy evaluation (low, moderate or high complexity) | About $98 |
| 97110 | Therapeutic exercise, each 15 minutes | About $29 |
| 97140 | Manual therapy, each 15 minutes | About $28 |
| 97112 | Neuromuscular reeducation, each 15 minutes | About $33 |
| 97530 | Therapeutic activities, each 15 minutes | About $35 |
| 97535 | Self-care and home management training, each 15 minutes | About $32 |
| 90912 | Pelvic floor biofeedback, first 15 minutes | About $82 |
| 90913 | Pelvic floor biofeedback, each additional 15 minutes | About $33 |
A few things to keep in mind when reading this table:
- These are Medicare rates, not your bill. Private insurers negotiate their own rates, and clinics set their own cash prices. Most new moms aren't on Medicare. We use it because it's the one national, public price list.
- Multiple units in one visit pay less. CMS applies a 50% reduction to the practice expense part of certain therapy codes when several are billed together [8], so a multi-unit visit pays less than adding up the rows.
- Rates vary by location. Medicare adjusts each amount up or down by region [8].
If you're paying cash, ask each clinic for its self-pay rate for the evaluation and for a follow-up visit, and ask whether it offers package pricing. If you aren't using insurance, the No Surprises Act gives you the right to a written Good Faith Estimate of expected charges when you schedule at least 3 business days ahead or ask for one [19]. Keep it: you need the estimate to dispute a bill that comes in much higher [19].
For how therapy fits with the rest of your birth costs, see our guide to the cost of having a baby.
Does insurance cover pelvic floor therapy?
Usually, yes, as long as it's medically necessary and billed as physical therapy. Most plans don't treat it differently from therapy for a sore back or a knee.
Every Marketplace plan must cover ten essential health benefits, and two of them matter here: "pregnancy, maternity, and newborn care," which covers care before and after birth, and "rehabilitative and habilitative services and devices" [6]. Pelvic floor therapy is billed under the second, rehabilitative services, which is why physical therapy limits and cost sharing apply rather than your maternity benefit. Most job-based plans are set up the same way.
What to expect from a typical private plan:
| Plan feature | How it usually affects pelvic floor therapy |
|---|---|
| Deductible | You may pay the full allowed amount until you meet it. If you met your deductible with the birth, therapy later in the same plan year may cost much less. |
| Copay or coinsurance | Applies per visit. Some plans charge a specialist copay for therapy. |
| Visit limit | Many plans cap physical therapy visits per year, often combined with occupational therapy. |
| Referral | HMOs and some other plans require a referral from your primary care clinician or OB. |
| Prior authorization | Some plans approve a set number of visits, then require the therapist to request more. |
| Network | Out-of-network therapists usually cost more, and some plans don't pay them at all. |
Your plan's Summary of Benefits and Coverage (SBC) lays out these rules in plain language, and insurers and job-based plans must give you one on request at any time [7]. The SBC also includes a coverage example for having a baby [7], which shows roughly what the plan pays for a typical birth.
Timing matters. If your plan year resets on January 1 and you gave birth in the fall, therapy after the reset starts a new deductible and a new visit count. Ask your plan when your deductible and therapy visit limit reset.
What CPT codes does pelvic floor therapy bill under?
Pelvic floor therapy uses the standard physical therapy codes, plus two pelvic floor biofeedback codes. Knowing them helps when you call your insurer, because coverage questions go faster with codes.
- Evaluation: 97161, 97162 or 97163, depending on complexity [8].
- Treatment units: commonly 97110 (therapeutic exercise), 97112 (neuromuscular reeducation), 97140 (manual therapy), 97530 (therapeutic activities) and 97535 (self-care training) [8].
- Biofeedback: 90912 for the first 15 minutes of one-on-one biofeedback training of the perineal muscles or anorectal or urethral sphincter, and 90913 for each additional 15 minutes. These replaced the old code 90911, and 90913 can't be billed without 90912 [9].
CMS publishes an annual list of the codes it treats as therapy services [10]. When you call your insurer, ask whether each code is covered for outpatient physical therapy, whether it counts toward your visit limit and whether any need prior authorization.
The therapist's office will also put a diagnosis code on the claim. You don't need to pick one, but if a claim is denied, ask the office which diagnosis it used and whether your clinician's referral notes support it.
Do you need a referral for pelvic floor physical therapy?
Under state law, often no. Under your insurance, often yes. These are two separate rules, and the stricter one usually decides.
According to the American Physical Therapy Association (APTA), all 50 states, DC and the U.S. Virgin Islands provide some form of direct access to physical therapists, meaning you can be evaluated or treated without a prescription. The details vary by state, and many states attach conditions such as a time or visit limit before a referral is needed [4]. APTA's state-by-state summaries were current as of July 2025 [4].
Your health plan is a separate gatekeeper. Even in a state with unrestricted direct access, an HMO or a Medicaid program may not pay for therapy without a referral or prescription. California's Medicaid program, for example, covers physical therapy only when it's prescribed by a physician or another licensed practitioner [13].
The simplest approach: ask for a referral at your postpartum visit even if you aren't sure you'll use it. It costs nothing and keeps every payment option open. You can find clinicians who take your insurance in our OB-GYN directory or midwife directory.
Does Medicaid cover pelvic floor therapy after birth?
It depends on your state. Physical therapy is an optional Medicaid benefit, so each state decides whether to cover it for adults and with what limits [11].
KFF's most recent survey of state Medicaid physical therapy benefits, from 2018, found 40 states covered physical therapy for adults in fee-for-service Medicaid, 6 didn't and 5 didn't report [12]. Many covering states set limits. Examples from that survey [12]:
| State (2018) | Physical therapy limit in fee-for-service Medicaid |
|---|---|
| Kentucky | 20 visits a year |
| North Dakota | 1 evaluation and 15 visits a year |
| Ohio | 30 visits a benefit year without prior authorization |
| Wisconsin | Prior approval required after 35 visits |
| Wyoming | Prior authorization required after the first 20 visits |
| Texas | Prior authorization required |
That data is several years old, and most Medicaid members today are in managed care plans that may set their own rules. Treat the table as a picture of how limits work, not as your state's current rule.
California is a good example of how rules layer. California's Medicaid state plan, approved by CMS in 2022, says physical therapy treatment-plan prescriptions last six months and can be renewed for medical necessity, and that physical therapy is subject to prior authorization in its fee-for-service program [13]. Medi-Cal managed care plans can be looser. One, Health Plan of San Joaquin, stopped requiring prior authorization for outpatient physical therapy with in-network providers in July 2024 [14]. That's why the most useful call is to your own Medicaid health plan.
Postpartum Medicaid lasts longer than it used to. Most states now keep pregnancy Medicaid for 12 months after birth, which gives you time to start and finish a course of therapy. Our guide to postpartum Medicaid coverage explains the rules, and Medicaid for pregnancy by state shows your state's details. If you're not sure you qualify, try our benefits checker.
TRICARE covers physical therapy from a licensed physical therapist when it's professionally administered to aid recovery from disease or injury. It excludes routine exercise programs and maintenance therapy, and it tells members to ask their regional contractor about specific limits [15].
Do any states require insurance to cover postpartum pelvic floor therapy?
Not yet, as far as we could find. Bills have been introduced, but we found none enacted as of October 2026.
- New York. Assembly bill A8144 and its Senate companion, S4917, would add postpartum pelvic floor therapy to the minimum maternity benefits that state-regulated health insurance must cover, alongside parent education and feeding help. The bill text sets no visit cap. The latest version would take effect on the January 1 after it becomes law. As of its last action on April 9, 2026, the Assembly bill was amended and sent back to the Insurance Committee [16].
- New Hampshire. HB1656, a 2026 bill on insurance coverage for pelvic health therapy, was found "inexpedient to legislate" by a 15-0 committee vote, and the House adopted that recommendation in March 2026 [17].
State insurance mandates like New York's generally apply only to plans regulated by that state. Self-funded employer plans, which many large employers use, typically follow federal rules instead, so a state law may not reach your plan. Ask your HR department whether your plan is fully insured or self-funded.
Can you use an HSA or FSA for pelvic floor therapy?
Generally, yes. IRS Publication 502 says you can include amounts you pay for therapy received as medical treatment in your medical expenses [18]. Health savings accounts and health flexible spending accounts reimburse those same medical expenses.
A few practical points:
- Keep itemized receipts showing the provider, date and service.
- If your administrator asks for proof that the therapy is medical, a referral or letter from your clinician usually answers it.
- A dependent care FSA is a different account for child care, and it can't be used for therapy. Our dependent care FSA guide explains what that account does cover.
How do you find a pelvic floor physical therapist near you?
Start with your health plan's directory, then cross-check with the Academy of Pelvic Health Physical Therapy's PT Locator.
- Your plan's directory. Search for physical therapists and filter or search for "pelvic health," "pelvic floor" or "women's health." In-network is almost always cheaper.
- The APTA Pelvic Health PT Locator. The Academy's free directory lets you search by city, state or ZIP code and filter by pregnancy and postpartum care, telehealth, home visits, languages and insurance or cash payment [5]. Listings are self-reported: therapists opt in, and the Academy says it doesn't verify the information or endorse anyone listed [5].
- Ask about training. The PT Locator lets you filter by two credentials: the board-certified Pelvic and Women's Health Clinical Specialist and the Academy's Certificate of Advanced Practice in pelvic or obstetric health. The Academy notes that other training exists too, so ask each therapist about theirs [5].
- Ask your OB-GYN or midwife. Many practices know which local therapists treat postpartum patients and which take your insurance.
When you call a clinic, ask whether it's in network with your specific plan, not just your insurer. A clinic can take one Blue Cross or Aetna plan and not another.
What to ask before your first visit: a checklist
Call the member services number on your insurance card and ask:
- Is outpatient physical therapy covered, and is pelvic floor therapy treated the same way?
- How many physical therapy visits do I get per plan year, and is the limit shared with occupational therapy?
- Do I need a referral or prescription, and from whom?
- Do I need prior authorization, and for how many visits at a time?
- Are codes 97161 to 97163, 97110, 97112, 97140, 97530, 90912 and 90913 covered for outpatient therapy?
- What's my copay or coinsurance per visit, and how much of my deductible is left?
- Is this therapist (give the name and NPI number) in network for my plan?
- When does my deductible and visit count reset?
Write down the date, the representative's name and the call reference number. If a claim is later denied, ask the plan for the reason in writing, then ask the therapist's office whether a corrected claim or a letter from your clinician would help before you file an appeal.
If you're also lining up other help after birth, our guide to whether insurance covers lactation consultants uses the same step-by-step approach.
What should you do before your first visit?
Pelvic floor therapy after birth is usually covered, but as physical therapy, with physical therapy's limits. Before your first visit, get a referral at your postpartum checkup, check your plan's visit limit and authorization rules, and confirm the therapist is in network. If you're paying cash, ask for a Good Faith Estimate and use HSA or FSA money if you have it. And for any question about whether you need therapy, or what kind, talk with your own OB-GYN, midwife or primary care clinician.
Questions people ask
Does insurance cover pelvic floor therapy?
Usually, yes, when it's medically necessary. Most plans cover it as outpatient physical therapy, so your deductible, copay or coinsurance and any yearly visit limit apply; your Summary of Benefits and Coverage lists the limit. Some plans require a referral or prior authorization, so call the number on your card before your first visit.
How much does pelvic floor therapy cost without insurance?
There's no national survey of cash prices, so ask each clinic for its self-pay rate and a written Good Faith Estimate, which providers must give self-pay patients on request. For context, Medicare's 2026 national rate is about $98 for an evaluation and $28 to $35 per 15-minute treatment unit.
Do I need a referral for pelvic floor physical therapy?
Not always. Every state allows some form of direct access to a physical therapist, but many states add conditions, and many health plans and Medicaid programs still require a referral or prescription before they'll pay. Ask your OB, midwife or primary care clinician for a referral at your postpartum visit to keep your options open.
Does Medicaid cover pelvic floor therapy after birth?
It depends on your state. Physical therapy is an optional Medicaid benefit, and states that cover it often set visit limits or require prior authorization. Call your Medicaid health plan and ask how many physical therapy visits you get and whether you need a prescription.
Can I use my HSA or FSA for pelvic floor therapy?
Generally, yes. IRS Publication 502 says therapy received as medical treatment counts as a medical expense, which is what HSAs and health FSAs pay for. A dependent care FSA can't be used for it.
How do I find pelvic floor physical therapy near me?
Start with your health plan's provider directory and search for physical therapists who treat pelvic health. The Academy of Pelvic Health Physical Therapy also runs a free PT Locator you can filter by location, pregnancy and postpartum care, telehealth and insurance or cash payment.
Sources
Numbers in brackets in the guide link to these sources.
- 1.ACOG Committee Opinion No. 736: Optimizing Postpartum Care (Obstetrics & Gynecology, 2018;131(5):e140-e150)American College of Obstetricians and Gynecologists, via PubMed (National Library of Medicine), 2018
- 2.What are the treatments for pelvic floor disorders?Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- 3.What causes pelvic floor disorders?Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- 4.Direct Access by StateAmerican Physical Therapy Association (APTA), 2025
- 5.PT LocatorAcademy of Pelvic Health Physical Therapy (APTA Pelvic Health), 2026
- 6.What Marketplace health insurance plans coverHealthCare.gov (Centers for Medicare & Medicaid Services)
- 7.Summary of Benefits and CoverageHealthCare.gov (Centers for Medicare & Medicaid Services)
- 8.PFS Relative Value Files: RVU26D (2026 National Physician Fee Schedule Relative Value File, October release)Centers for Medicare & Medicaid Services (CMS), 2026
- 9.CPT Code Updates (biofeedback codes 90912 and 90913)Academy of Pelvic Health Physical Therapy (APTA Pelvic Health), 2020
- 10.Annual Therapy Update (therapy code lists)Centers for Medicare & Medicaid Services (CMS), 2026
- 11.Mandatory & Optional Medicaid BenefitsMedicaid.gov (Centers for Medicare & Medicaid Services)
- 12.Medicaid Benefits: Physical Therapy Services (2018)KFF, 2018
- 13.California State Plan Amendment 22-0044: Physical TherapyCenters for Medicare & Medicaid Services (CMS), Medicaid.gov, 2022
- 14.Update to Changes to Prior Authorization Requirements for Physical Therapy VisitsHealth Plan of San Joaquin / Mountain Valley Health Plan (Medi-Cal managed care plan), 2024
- 15.Physical TherapyTRICARE (Defense Health Agency)
- 16.Assembly Bill A8144 (2025-2026 session): Requires health insurance contracts cover postpartum pelvic floor therapyNew York State Senate, 2026
- 17.HB1656-FN (2026): relative to insurance coverage for pelvic health therapyNew Hampshire General Court, 2026
- 18.Publication 502 (2025): Medical and Dental ExpensesInternal Revenue Service (IRS), 2025
- 19.Understanding costs in advance: good faith estimatesCenters for Medicare & Medicaid Services (CMS)
