To have SGK (Social Security Institution) cover physical therapy costs, treatment must be provided at a private hospital that has an agreement with SGK. In addition, the patient must have a valid medical report and meet specific conditions for SGK to cover physical therapy expenses. Whether costs are covered is decided based on the patient’s condition and the content of the report.
The number of sessions, treatment location, and the right to renew the report within the year determine which expenses will be covered. If the SGK report specifies it, expenses for a companion of the person receiving treatment may also be covered. If the treatment does not proceed within the prescribed timeframe or conditions are not met, the physical therapy report may be canceled.
Does SGK Cover Physical Therapy Costs?
SGK coverage for physical therapy applies under defined conditions. Patients who meet the legal requirements have their physical therapy fees covered by SGK. This means patients can receive physical therapy without charge at both public and SGK-contracted private hospitals. However, SGK covers only the treatment fees.
Therefore, any contribution fee requested by private hospitals is the responsibility of the patient. Those with supplementary health insurance are not required to pay the contribution, as their policies can cover the difference. Individuals up to age 80 may apply for supplementary health insurance.
For SGK to pay for physical therapy in private hospitals, the patient must present a doctor’s report. Specialists must assess the patient’s health and determine that physical therapy is necessary.
SGK covers the cost of physical therapy applied by a physiotherapist up to 30 sessions for a single body region within one year. For treatments lasting up to one month, a single specialist doctor’s report indicating the treatment is required. If the patient needs 60 or more sessions, a health board report is required.
What Are the Conditions for SGK to Cover Physical Therapy Costs?
Under SGK regulations, treatment fees are determined according to the Health Implementation Communiqué (SUT). Private hospitals have agreements with the state for physical therapy services. If patients obtain a medical report from the institution and meet the required conditions, treatment expenses are covered by the state.
The necessary conditions for SGK to cover physical therapy costs are:
- A treatment report for 31–60 sessions issued by at least one physical medicine and rehabilitation specialist is required.
- For 60 sessions or more to be covered by SGK, a health board report is required.
- The facility providing physical therapy must have a contract with the state.
- Treatment must begin within 15 days after the medical report’s issuance date.
- Outpatient physical therapy patients are covered for at most one session per day; inpatients receive coverage for one session per day for the same region.
- Bed fees, tests, medications, and medical supplies unrelated to inpatient physical therapy are covered by SGK if billed under SUT provisions.
- Within the same year, SGK covers up to 30 sessions for the same region and up to 60 sessions for different body regions in total.
- Two medical reports may be issued for the same region in a year. Right and left regions are considered separate. However, for diagnoses marked with SUT and code G80, region limits do not apply.
Who Is Not Covered by SGK for Physical Therapy?
SGK does not cover physical therapy fees for the following patients:
- Uninsured individuals receiving physical therapy in private hospitals.
- Those without a green card (for low-income or uninsured benefits).
- Individuals with outstanding General Health Insurance (GSS) premium debts.
- Patients who do not attend the sessions listed on their physical therapy report.
- If a patient’s medical report has expired and not been renewed, SGK does not cover their private hospital physical therapy until the report is updated.
Situations in Which SGK Does Not Cover Physical Therapy Costs
Situations where SGK will not pay physical therapy fees include:
- Costs associated with G93.1 anoxic brain injury for a diagnosis coded as G80 cerebral palsy are not covered.
- If more than five business days pass with an interruption after starting therapy, a new medical report is required; otherwise SGK will not pay.
- If patients are found to misuse their medical reports, SGK will refuse payment.
- If treatment does not start within two weeks after the report is issued and five consecutive treatment days are missed, SGK will not cover the costs.
- If the report specifies duration rather than number of sessions, SGK will not pay once the report’s duration expires, regardless of remaining session count.
- If multiple sessions are taken on the same day, SGK does not pay for the second session that day.
- When multiple reports exist for the same region, payment continues until the second report is issued; afterwards, coverage follows the latest valid report.
Which Applications Does SGK Cover for Physical Therapy?
SGK-contracted physical therapy services covered include:
- Physical therapy for fracture sequelae.
- Treatment for lumbar and cervical disc herniation.
- Therapy for osteoarthritis in private hospitals.
- Treatment for osteoporosis.
- Physical therapy for joint and ligament injuries.
- Supportive therapy for spastic children in private hospitals.
- Treatment fees for neck, back, and lumbar pain.
- Therapies for muscle spasms and post-injury rehabilitation.
- Post-stroke physical therapy in private hospitals.
- Physical therapy for nerve injuries in contracted private centers.
- Postoperative supportive physical therapy.
- Rheumatologic treatments provided in private hospitals.
- Orthoses, splints, assistive devices, collars, and corsets provided under SGK agreements.
Which Service Types Does SGK Cover for Physical Therapy?
SGK covers the following physical therapy modalities:
- Thermotherapy
- Superficial heat applications
- Cold therapies
- Electrotherapy
- Phototherapy
- Deep heat applications
- Electrical current therapies
- Electrical stimulation
- Vacuum therapies
- Laser therapies
- Shock wave therapy
- Specific exercise therapies
- Traction therapies
- Pneumatic compression (Lymphedema press)
- Interferential therapy
- Diathermy
- Massage therapy
- Hydrotherapy
- Applications including lymphatic therapy
- Kinesiotherapy
- Exercise therapy
If the Treatment Region Changes, Does SGK Continue to Cover Costs?
SGK may continue to cover physical therapy costs after a change in the treated region, provided appropriate reports are submitted. If multiple regions require therapy, separate reports should be obtained for each region.
If damage is reported in multiple body areas, SGK covers up to 60 sessions. Coverage does not change for disabled individuals who have impairments in more than one body area.
Does SGK Cover Home Physical Therapy Costs?
SGK does not generally cover home physical therapy costs because home-based treatments are treated as special services. Nevertheless, not every patient can receive home physical therapy even if SGK does not pay; it is limited to those who are medically certified as unable to leave home.
Does SGK Cover Spa (Thermal) Treatment Costs?
For SGK to cover spa (thermal) treatment, a medical report stating that the patient requires spa therapy for treatment is necessary. SGK may cover the patient’s spa treatment, accommodation, and meal expenses. A fixed allowance is allocated for those going to the spa. A specific medical report prepared by a doctor is required for payment of spa expenses.
What Are the Requirements of the Report for SGK to Cover Spa Treatment?
A spa treatment report must be prepared by a doctor and include the diagnosis necessitating spa therapy. The report must specify the duration of the spa treatment required.
The identity details on the report must match the patient’s ID. Spa treatment reports are prepared according to the affected region and require only the doctor’s approval to proceed. If multiple regions need spa therapy, separate reports are required. Each region’s report permits up to 30 sessions; for multiple regions, a combined maximum of 60 spa sessions is allowed.
Spa treatment reports are valid for 6 months. Patients must begin spa therapy within 6 months after receiving the report. If the patient goes to the spa within 5 business days after the report is issued and approved, SGK also covers travel expenses.
Travel reimbursement is calculated based on road transport. If the patient chooses to travel by plane to the spa location, flight costs are not covered. SGK has agreements with 242 spas whose costs it can cover.
Patients may obtain spa treatment reports twice a year with SGK support. For multiple regions, up to four spa treatment reports per year are allowed for visits to SGK-contracted spas. If the patient does not attend five consecutive treatment days, the spa treatment report is canceled.
Does SGK Cover Companion Costs for Physical Therapy?
SGK covers companion expenses only for patients whose medical reports indicate a need for a companion. If the report specifies a companion for disabled or elderly patients, both the patient’s and the companion’s spa expenses are covered. For other patients, payments are made for a single person even if they attend with a companion.
How Much Are Physical Therapy Fees?
Physical therapy fees were updated in 2021 according to the SUT. Treatment and rehabilitation costs vary by disease group. Session fees across groups range from 20 to 85 TL per session.
For conditions listed in the SUT bulletin, the session fee is set at 85 TL. Muscle strengthening and treatments for the hands and legs fall into group D with a fee of 20 TL per session. Group A conditions, such as cervical and lumbar disc herniations with neurological effects, have a maximum session fee of 85 TL. Fees at SGK-contracted centers and hospitals are calculated according to this tariff.
How to Check Physical Therapy Entitlement?
To check physical therapy entitlement, follow these steps:
- Visit https://www.turkiye.gov.tr/.
- Open the e-services menu from the homepage.
- Find the Social Security Institution among the institutions.
- Under SGK services, click the “Treatment Information Query” option.
- The page requires identity verification using an e-government password, mobile signature, electronic signature, T.R. identity card, or internet banking credentials.
- The page will display the individual’s treatment entitlements. If a physical therapy report exists, detailed information about SGK coverage for physical therapy will be shown.