Getting outpatient therapy? Be sure you know Medicare’s limits

Are you getting physical therapy after a hip replacement? Speech-language pathology services after a stroke? Anytime you get outpatient physical therapy, occupational therapy or speech-language pathology services, be sure you know the limits for how much Medicare will pay.

Medicare helps pay for medically-necessary outpatient physical and occupational therapy, and speech-language pathology services. There are limits, called “therapy caps,” on these services when you get them from most outpatient providers.

The therapy cap amounts for 2012 are:

  • $1,880 for physical therapy (PT) and speech-language pathology (SLP) services combined
  • $1,880 for occupational therapy (OT) services

You may qualify to get an exception so that Medicare will continue to pay its share for your services after you reach the therapy cap limits. Your therapist must document your need for medically-necessary services in your medical record, and your therapist’s billing office must indicate on your claim for services above the therapy cap that your outpatient therapy services are medically necessary.

Learn more about Medicare’s limits on therapy services.

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