Is Pelvic Floor Therapy Covered By Insurance? A Comprehensive Guide for Expecting and New Parents

You’re pregnant, or newly postpartum, and trying to do everything right. You’ve scheduled your glucose test, lined up your pediatrician, and even built a stroller comparison spreadsheet. You’ve downloaded the baby data tracking apps and can change diapers with your eyes closed. But what about your pelvic floor?

For many pregnant and postpartum people, pelvic floor therapy can make a huge difference in recovery, comfort, and long-term core health. So it’s only natural to ask: is pelvic floor therapy covered by insurance?

The good news is that, yes, most health insurance plans offer coverage for pelvic floor therapy. However, for the most affordable care, it’s important to find an in-network provider and understand the details of what your specific plan allows. This detailed guide will walk you through step-by-step how insurance coverage works for pelvic floor therapy, and how to make the most of the benefits available to you. 

Insurance Coverage for Pelvic Floor Therapy

How much you’ll pay for pelvic floor therapy is influenced by several factors, including your specific insurance plan, the medical diagnosis necessitating therapy, and the network status of the physical therapist you choose.

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In-network vs. out-of-network providers

Insurance plans often have networks of healthcare providers with whom they have contracted to provide services at negotiated rates. Your out-of-pocket costs can differ significantly based on whether your chosen pelvic floor therapist is considered in-network or out-of-network:

• In-network providers: Opting for an in-network therapist typically results in lower out-of-pocket expenses. After meeting your annual deductible, you will generally pay your standard copay or coinsurance amounts, and the insurance company will cover the remaining costs based on their pre-negotiated rates with the provider.
• Out-of-network providers: Seeing an out-of-network therapist usually means you will pay a larger percentage of the cost. While your insurance plan may still offer some reimbursement, it is often at a lower rate than for in-network services. You may also need to pay the therapist’s full fee upfront and then submit a claim to your insurance company for reimbursement.

If you choose to see an out-of-network provider, always inquire if they can provide you with a superbill. A superbill is a detailed invoice that includes all the necessary information, such as the diagnostic and treatment codes, provider information, and payment details, which you can then submit directly to your insurance company for potential reimbursement. However, there is no guarantee of reimbursement, and the amount you receive may be less than the amount you paid.

Medical necessity requirement

Insurance providers typically cover medical treatments deemed medically necessary. This means that therapy is prescribed to address a specific health issue rather than for preventative or wellness purposes alone. Common diagnoses that often qualify for pelvic floor therapy coverage include:

• Urinary incontinence (stress, urge, or mixed)
• Pelvic pain (chronic pelvic pain, vulvodynia, dyspareunia)
• Postpartum recovery (addressing pain, weakness, or dysfunction related to pregnancy and childbirth)
• Diastasis recti (abdominal muscle separation with associated symptoms)
• Pelvic organ prolapse (when pelvic organs descend into the vagina)

To establish medical necessity, your OB-GYN, midwife, or primary care physician will need to provide a diagnosis and a referral for pelvic floor therapy, clearly stating the medical reason for the treatment. This documentation is crucial for insurance approval.

Outpatient physical therapy benefits

Pelvic floor therapy is typically classified and billed under your insurance plan’s outpatient physical therapy benefits. As such, it is subject to the same coverage rules, limitations, and cost-sharing arrangements (such as copays, deductibles, and coinsurance) that apply to other physical therapy services.

Referrals and pre authorization

Many insurance plans have specific requirements that must be met before receiving physical therapy services, including pelvic floor therapy. Before starting care, call the Member Services number on the back of your insurance card to ask if any of the following apply to your plan: 

• A referral from a doctor: Some plans require a formal referral from your primary care physician or specialist (like your OB-GYN or midwife) before you can begin physical therapy.
• Prior authorization: Prior authorization involves obtaining approval from your insurance company before starting treatment. Failure to secure pre-authorization when required can lead to claim denial and unexpected out-of-pocket expenses.
• Limits on the number of covered sessions: Your insurance plan may impose a cap on the total number of physical therapy sessions they will cover per year or per specific condition. Understanding these limitations is important for planning your course of treatment.

Proactively verifying these requirements with your insurance provider before scheduling your initial appointment can prevent potential administrative hurdles and financial surprises down the line.

Coverage by insurance provider

Insurance coverage for pelvic floor therapy can vary depending on the insurance provider and the specifics of your plan. Here's a general overview of common insurances:

BlueCross BlueShield

Generally, BlueCross BlueShield offers coverage for pelvic floor therapy under outpatient physical therapy benefits. However, demonstrating medical necessity through a documented diagnosis is typically required, and a physician referral may also be necessary depending on your specific policy and state regulations. Coverage details can differ significantly between individual BCBS plans and across various states.

Cigna

Cigna often covers pelvic floor physical therapy when a documented medical diagnosis supports the need for treatment. Pre-authorization is a common requirement with Cigna plans, so it's essential to obtain approval before starting therapy to ensure coverage.

Aetna 

Aetna typically covers pelvic floor physical therapy when it’s deemed medically necessary. This means you’ll need a relevant diagnosis, like urinary incontinence, pelvic pain, diastasis recti, or prolapse, and documentation from a provider (such as your OB-GYN or midwife). Most Aetna plans require a referral from your doctor before therapy begins. Some plans also require prior authorization, especially if you’ll be attending more than a few sessions. Coverage is generally included under outpatient physical therapy benefits. Co-pays, deductibles, and visit limits vary based on your plan.

United Healthcare 

UnitedHealthcare generally covers pelvic floor therapy under their outpatient rehab benefits, as long as it's medically necessary. Conditions like postpartum pelvic pain, incontinence, or recovery after birth typically qualify. Most UHC plans require a referral from your healthcare provider. Prior authorization is common, especially after a certain number of visits (often after 6–12 sessions). Some employer-sponsored or state-specific plans may be more generous in the postpartum period so it’s worth asking customer service for details. Pelvic floor therapy is billed like other PT services; your costs will depend on whether the provider is in-network and how much of your deductible you've met.

Medicare

Medicare Part B covers outpatient physical therapy, including pelvic floor therapy, when deemed medically necessary by a physician. You will likely need to see a physical therapist who participates in the Medicare program. Your doctor must certify the need for therapy, and you may be responsible for co-insurance and deductible amounts.

Medicaid

Medicaid coverage for pelvic floor therapy varies considerably from state to state. Some state Medicaid programs include pelvic floor therapy as part of their women’s health benefits or general physical therapy coverage, while others may have more restrictive policies. If you have Medicaid, it is crucial to contact your state’s Medicaid office or your specific managed care plan to understand the available benefits and any specific requirements.

A step-by-step guide to verifying your insurance coverage

To proactively understand your pelvic floor therapy benefits, contact your insurance provider by calling the number on the back of your insurance card. Be prepared to ask specific questions, such as:

• Does my plan cover outpatient pelvic floor physical therapy?
• What are my specific physical therapy benefits?
• Do I need a referral from my doctor to see a pelvic floor physical therapist?
• Does my plan require pre authorization or prior authorization for pelvic floor physical therapy services? If so, what is the process?
• Are there any limitations on the number of pelvic floor physical therapy sessions covered per year or per condition?
• What are my copay, deductible, and coinsurance amounts for outpatient physical therapy services?
• Does my plan have a network of preferred physical therapy providers? 
• How can I find in-network providers in my area?

How to find a pelvic floor therapist 

Pelvic floor therapists are licensed physical therapists who have completed advanced training in evaluating and treating the muscles and connective tissue of the pelvic region. Unlike general physical therapists who focus on sports injuries or joint rehab, these specialists understand the unique anatomy and hormonal changes of pregnancy, postpartum, and beyond.

Because pelvic health is a specialized and in-demand field, in many locations, it can be difficult to find a trained pelvic floor therapist.. Many pelvic floor therapists run small, independent practices and opt out of insurance networks altogether, because insurance reimbursement rates often don't reflect the time-intensive, hands-on nature of the care pelvic floor specialists provide. So while their services are often eligible for reimbursement, you may need to pay upfront, get a superbill, and advocate with your insurance for coverage.

The cost of pelvic floor therapy

If your insurance plan includes pelvic floor therapy, the next thing you want to check is whether your provider is in-network. In-network therapists have agreed to a set rate with your insurance company, which usually means predictable copays and less paperwork. 

If your therapy is approved, and your provider is in-network, most insurance plans will cover pelvic floor PT under their outpatient physical therapy benefits. These services include:

• Initial evaluation
• Manual therapy and trigger point release
• Dry needling (if approved and provided by a licensed therapist)
• Neuromuscular re-education and electrical stimulation
• Exercise instruction and follow-up visits

It is important to remember that “coverage” doesn’t mean free. Depending on your plan, you may still have a co-pay, coinsurance, or deductible to meet before insurance kicks in. Ask your insurance provider exactly how much you’ll be responsible for and check back in every few months if you’re tracking progress towards your deductible. 

If your plan doesn’t cover pelvic floor therapy, or the only provider you can find is out-of-network, meaning they don’t have a contract with your insurance, you still have options:

• Ask for a superbill: This is a detailed invoice from your provider that you can submit to your insurance for reimbursement.
• Use your HSA or FSA: Pelvic floor therapy is usually eligible for payment with pre-tax dollars.
• Pay out of pocket: Some practices offer package rates or sliding scales for cash-pay clients.

Pelvic floor therapy for pregnancy and postpartum health

Pelvic floor therapy is a specialized branch of physical therapy focusing on the network of muscles that support the pelvic organs, including the bladder, uterus, and rectum. These muscles undergo significant stress and adaptation during pregnancy, childbirth (regardless of delivery method), and the subsequent postpartum recovery phase.

A qualified pelvic floor physical therapist (PFPT) will build a treatment plan with a range of interventions to address various concerns, including:

• Restoring core and pelvic strength postpartum: Pregnancy and delivery can weaken these essential muscle groups. Therapy helps rebuild strength and coordination, crucial for overall stability and function.
• Alleviating urinary incontinence and urgency: Many individuals experience involuntary urine leakage or a frequent urge to urinate during and after pregnancy. PFPT can identify the underlying causes and implement strategies for improved bladder control.
• Managing pelvic pain: Pain in the pelvic region, including discomfort during sexual activity or while sitting, is a common issue that pelvic floor therapy can effectively address through targeted exercises and manual techniques.
• Supporting diastasis recti healing: This separation of the abdominal muscles is prevalent postpartum. A PFPT can guide you through safe and effective exercises to promote healing and restore core integrity.
• Improving bowel function and reducing constipation: Pelvic floor dysfunction can contribute to bowel issues. Therapy can help improve muscle coordination, alleviate constipation, and address fecal incontinence.
• Preparing the pelvic floor for a smoother birth: Prenatal pelvic floor therapy can educate expectant mothers on how to relax and effectively use these muscles during labor, potentially leading to a less stressful delivery.

Whether you welcomed your baby vaginally or via Cesarean section, pelvic floor therapy offers significant benefits in promoting a more complete recovery and fostering a stronger connection with your body. Addressing pelvic floor health is an integral part of holistic postpartum care.