Dear Medicare patients,
Medicare limits the amount it will pay for outpatient therapy services in one calendar year. These limits, or “therapy caps” are:
- $1,880 for physical therapy (PT) and speech-language pathology (SLP) services combined
- $1,880 for occupational therapy (OT)
What happens if you exceed the therapy cap?
- If your therapy services exceed the therapy cap, you may be financially responsible for any services provided above the $1,880 caps.
- If your therapy services exceed the therapy cap, your therapist can ask for an exception. In these instances, our billing team works hard to request exceptions for you.
- Even if we ask for an exception, this isn’t a guarantee that you won’t have to pay for costs above the $1,880 therapy cap amounts. If Medicare decides, at any time (even after your therapy services have been paid for), that your therapist or doctor didn’t show enough proof that your therapy services were medically necessary, then you may have to pay for the total cost of the services above the $1,880 therapy cap amounts.
How do I do know if I exceed the cap?
Please talk to your therapist or doctor about any therapy services you’ll receive for the rest of the year. Our billing team is also available to help answer any questions you may have about the amount paid for your therapy services so far this year. Just call (434) 836-4158 and ask to speak to a billing team member about your Medicare account.