Monday, November 14, 2016

Medicare Part B Therapy Cap Values for Calendar Year (CY) 2017

Dan Ciolek


The Centers for Medicare and Medicaid Services (CMS) recently announced a $20 update to the annual per-beneficiary Medicare Part B outpatient therapy caps for CY 2017. For physical therapy (PT) and speech-language pathology (SLP) combined, the 2017 therapy cap will be $1,980. For occupational therapy (OT), the cap for 2017 will be $1,980. The effective date is January 1, 2017. Make sure that your billing staffs are aware of these therapy cap value updates.


Background:

The Balanced Budget Act of 1997 (P.L. 105-33), Section 4541(c) applies annual financial limitations on expenses considered incurred for outpatient therapy services under Medicare Part B per beneficiary, commonly referred to as “therapy caps.” Therapy caps are updated each year based on the Medicare Economic Index. An exception for the therapy caps for reasonable and medically necessary services has been in place since CY 2006. Originally required by Section 5107 of the Deficit Reduction Act of 2005, the exceptions process for the therapy caps has been continuously extended multiple times through subsequent legislation. The current therapy caps exceptions process, and associated targeted medical review for claims over a $3700 annual PT/SLP or OT threshold, as required by Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015, expires on December 31, 2017.

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