Medicare Physical Therapy Cap

Beginning January 1, 2008, Medicare has imposed a $1810 cap on outpatient physical therapy and speech language pathology benefits combined. This cap applies to Medicare Part B outpatient therapy services furnished by rehabilitation agencies, physician’s offices, comprehensive outpatient rehabilitation facilities, skilled nursing facilities home health agencies and physical therapist in private practice.

This cap does not apply to outpatient services furnished directly or under arrangements by hospitals to an outpatient or to an inpatient who is not covered by Part A stay. The limitations will apply to outpatient rehabilitation services furnished by a separately-certified hospital based provider, such as a hospital based Skilled Nursing Facility.

Therapy services include only outpatient physical therapy, occupational therapy and speech therapy (Part B) in outpatient settings paid under the Medicare Physician Fee schedule. These services are identified by a plan of care and codes therapists use during billing. Each Medicare beneficiary who uses therapy services will find the total dollar amount that is counted toward the caps for the year on each Medicare Summary Notice that reports payment for therapy services. Bounce Back Physical Therapy will do its best to inform patients if they are in danger of reaching the cap limitations, but we recommend that patients carefully track this dollar amount to ensure that the cap threshold is not exceeded.