If you are a current or future Medicare beneficiary, we want to keep you informed about Medicare coverage for outpatient therapy services.
What are the Medicare therapy caps?
Currently, 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, per patient, for January 1, 2012 through December 31, 2012
- $1,880 for occupational therapy (OT), per patient, for January 1, 2012 through December 31, 2012
Are there any exceptions to the Medicare therapy caps?
If your therapy services exceed the therapy cap, your therapist may be able to 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.
What happens on January 1, 2013?
As it stands today, the therapy caps will continue in 2013. However, therapy cap exceptions end on December 31, 2012. So, as of January 1, 2013, the therapy cap amounts will apply without exceptions.
Contact your local U.S. Congressman and U.S. Senators to ask them to extend the Medicare therapy cap exceptions, and/or to eliminate the Medicare therapy caps altogether!
Take Action in Virginia
If you are a Virginia resident, then your local legislators are:
- Jim Webb, US Senator, Virginia
- Mark Warner, US Senator, Virginia
- Robert Hurt, Congressman, Virginia, 5th District (includes Danville, Martinsville, Pittsylvania County, Henry County, and Halifax County)
- Find other Virginia Congressmen
Take Action in North Carolina
If you are a North Carolina resident, then your local legislators are:
- Richard Burr, US Senator, North Carolina
- Kay Hagan, US Senator, North Carolina
- Howard Coble, Congressman, North Carolina, 6th District (includes Summerfield)
- Brad Miller, Congressman, North Carolina, 13th District (includes Caswell, Person, Rockingham Counties)
- Find other North Carolina Congressmen