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In 1997 the Balanced Budget Act establishe … In 1997 the Balanced Budget Act established annual per-beneficiary Medicare spending limits, or therapy cap, for outpatient physical therapy, occupational therapy and speech language pathology services covered under Medicare Part B. Facilities affected by the therapy cap include: private practice, physician offices, skilled nursing facilities, rehabilitations agencies, comprehensive outpatient rehabilitation facilities, critical access hospitals, and outpatient hospital departments. For 2014, the therapy cap amount is $1920 for physical therapy and speech pathology combined. A separate $1920 is allowed for occupational therapy services. Beneficiaries enrolled in Medicare Advantage plans are not subject to the therapy cap unless the plan chooses to apply the cap. Beginning in 1999, Congress placed repeated moratoria on the Therapy Cap through 2006. In 2006, an exception process was put into place through the Deficit Reduction Act of 2005. The exception process allowed for additional therapy services "when medically necessary" up to $3,700 after which, a manual medical review was required before further payment was provided. Once the cap is reached, patients are required to pay out of pocket for further services. Without further legislation, the therapy cap exception process was to expire on March 31, 2015. At this time, hospital based outpatient clinics will no longer be subject to the therapy cap. On February 9, 2018, as part of the Bipartisan Budget Act of 2018, President Donald Trump permanently removed therapy caps when he signed the bill into law.apy caps when he signed the bill into law.
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In 1997 the Balanced Budget Act establishe … In 1997 the Balanced Budget Act established annual per-beneficiary Medicare spending limits, or therapy cap, for outpatient physical therapy, occupational therapy and speech language pathology services covered under Medicare Part B. Facilities affected by the therapy cap include: private practice, physician offices, skilled nursing facilities, rehabilitations agencies, comprehensive outpatient rehabilitation facilities, critical access hospitals, and outpatient hospital departments. For 2014, the therapy cap amount is $1920 for physical therapy and speech pathology combined. A separate $1920 is allowed for occupational therapy services. Beneficiaries enrolled in Medicare Advantage plans are not subject to the therapy cap unless the plan chooses to apply the cap. unless the plan chooses to apply the cap.
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