What Is Pelvic Floor Therapy and Who Needs It?

Pelvic floor dysfunction affects millions of people across the U.S., leading to discomfort, pain, and issues with bladder and bowel control. While pelvic floor physical therapy can significantly improve quality of life, many patients hesitate to start treatment because they aren’t sure what their insurance covers—or if it’s covered at all.

The good news? In many cases, pelvic floor therapy is covered by insurance, but the specifics can vary widely depending on your provider, diagnosis, and treatment plan. In this guide, we’ll break down what you need to know about insurance coverage, out-of-pocket costs, and how to navigate the system confidently.

What is Pelvic Floor Therapy?

Pelvic floor therapy focuses on strengthening or relaxing the muscles of the pelvic floor—muscles that support the bladder, uterus or prostate, and rectum. When these muscles are too tight, too weak, or uncoordinated, people can experience a range of issues including:

  • Urinary or fecal incontinence
  • Pelvic pain
  • Pain during intercourse
  • Postpartum muscle dysfunction
  • Constipation
  • Recovery after pelvic or abdominal surgery.

Both women and men can benefit from pelvic floor physical therapy. Treatment often includes:

  • Manual therapy to release tight muscles or trigger points
  • Therapeutic exercises to improve strength and coordination
  • Biofeedback to improve muscle awareness
  • Electrical stimulation to activate or calm the pelvic floor.

Is Pelvic Floor Therapy Typically Covered by Insurance?

Yes—most insurance plans do cover pelvic floor therapy when it’s deemed medically necessary. Coverage usually falls under the umbrella of outpatient physical therapy. That means if your insurance plan includes physical therapy benefits, pelvic floor therapy will likely be included.

However, how it’s covered depends on:

  • Your insurance carrier
  • Your diagnosis or referral
  • Whether your provider is in-network
  • Whether prior authorization is required.

Medicare, most private insurance plans, and some Medicaid programs cover pelvic floor therapy to some extent, though exact benefits vary.

What Treatments Might Be Included in Coverage?

Insurance often covers services when they are part of a physical therapy treatment plan. Common covered services may include:

  • Manual therapy (hands-on manipulation of muscles and fascia)
  • Therapeutic exercise (guided muscle training)
  • Electrical stimulation (to improve neuromuscular control)
  • Biofeedback (to help patients learn how to use pelvic muscles correctly)
  • Myofascial release (techniques to ease tight tissue).

Some specialized treatments, like internal manual therapy or advanced biofeedback tools, may require extra documentation or prior approval. Always ask your provider what services are included in your treatment plan and how they’ll be billed.

Common Billing Codes and Insurance Classification

Pelvic floor therapy is typically billed under standard physical therapy codes, such as:

  • 97110 – Therapeutic exercise
  • 97112 – Neuromuscular re-education
  • 97530 – Therapeutic activities
  • 97032 – Electrical stimulation (manual)
  • 90911 – Biofeedback for pelvic floor dysfunction.

Your diagnosis code (e.g., incontinence, pelvic pain, prolapse) and provider notes will affect whether a session is approved. Some insurance companies may flag pelvic floor therapy as a specialty service, so it’s important that documentation clearly connects the treatment to a medical need.

What Insurance Plans Cover Pelvic Floor Therapy?

Here’s a breakdown of the most common insurance types:

  • Employer-sponsored health plans: Usually offer coverage under standard PT benefits; check network restrictions and visit limits.
  • Medicare: Covers pelvic floor physical therapy under Part B if medically necessary and prescribed by a doctor. No referral is required for Original Medicare, but a plan of care is.
  • Medicare Advantage: Coverage rules vary. Some plans may require referrals or limit networks.
  • Medicaid: State-specific; some states cover PT services while others may have more limited benefits.
  • ACA marketplace plans: Vary widely—many include essential benefits like physical therapy but check the details of your plan.

If you’re unsure, ask your clinic if they accept insurance and whether they can verify your benefits before your first appointment.

How to Verify Insurance Coverage (Step-by-Step)

Before you schedule your first session, it’s smart to verify your coverage. Here’s how:

  1. Call your insurance provider (use the number on your ID card)
  2. Ask the following:
    • Is pelvic floor physical therapy covered?
    • Are there any copays or coinsurance fees?
    • Is there a limit on the number of visits per year?
    • Do I need a referral from my primary care provider?
    • Do I need prior authorization?
    • Is the provider in-network?

If you prefer, your provider’s office can usually verify coverage for you.

Sample Script:
“Hi, I’m calling to ask about my benefits for pelvic floor physical therapy. Can you tell me if it’s covered under my plan, and what my out-of-pocket costs might be?”

What to Expect If You’re Paying Out of Pocket

If your plan doesn’t cover therapy or you haven’t met your deductible, you may need to pay out of pocket. Costs vary by region and provider but typically range from $100 to $250 per session.

Ways to reduce costs include:

  • Using HSA/FSA funds to pay for care tax-free
  • Asking about package discounts for multiple sessions
  • Checking if the provider offers a sliding scale based on income
  • Choosing a self-pay rate (often lower than billed insurance rates).

Some patients choose to pay out of pocket to see highly specialized providers not in their network, especially if pelvic floor dysfunction is significantly affecting their daily life.

Choosing a Pelvic Floor Physical Therapist

Finding the right provider is essential. Look for:

  • Experience with pelvic floor conditions specific to your needs (incontinence, pelvic pain, postpartum care, etc.).
  • Certifications in pelvic health physical therapy (e.g., Herman & Wallace training).
  • A provider who accepts your insurance, or can explain out-of-pocket costs clearly.
  • Comfort with both internal and external therapy techniques, as needed.
  • Use of tools like electrical stimulation or biofeedback for a comprehensive approach.

Frequently Asked Questions (FAQs)

Does insurance cover pelvic floor therapy for women and men?

Yes. Coverage is based on medical necessity, not gender.

Is electrical stimulation covered in pelvic floor therapy?

Often yes, when it’s part of a treatment plan. Some plans require documentation or authorization.

What if my insurance doesn’t cover pelvic therapy?

You may pay out of pocket, use an HSA/FSA, or look for discounts. Some clinics offer payment plans.

Does Medicare pay for pelvic floor therapy?

Yes. Medicare Part B covers medically necessary pelvic floor therapy when prescribed by a doctor.

How many sessions will insurance typically cover?

Depends on your plan. Some cover a set number per year, while others are based on medical need.

Need Help Verifying Coverage for Pelvic Floor Therapy?

Insurance can be confusing—especially when you’re already dealing with the stress of pelvic floor issues. If you’re unsure whether your plan covers treatment or want help understanding your benefits, many clinics offer free insurance verification.

Schedule a consultation or ask for a benefits check before your first appointment. Knowing what to expect can give you peace of mind—and help you focus on healing.