Wednesday, November 15, 2017

Medicare Part B Therapy Cap Threshold Set at $2,010 for Calendar Year 2018


Recently, the Centers for Medicare & Medicaid Services (CMS) issued a Medicare Learning Network (MLN) Matters article number MM10341 announcing the Medicare Part B outpatient therapy cap values for calendar year (CY) 2018.

The article notes that the annual per-beneficiary benefit limits for physical therapy and speech-language pathology services combined (PT/SLP) is $2,010, while occupational therapy services have a separate $2,010 cap.

While there is currently activity in Congress to repeal the therapy caps before the end of the year, there is no guarantee it will occur. Providers should prepare and make sure that therapy and billing staff are aware of these therapy cap value updates.

Background

The Balanced Budget Act of 1997, P.L. 105-33, Section 4541(c) applies, per beneficiary, annual financial limitations on expenses considered incurred for outpatient therapy services under Medicare Part B, commonly referred to as “therapy caps.” The therapy caps are updated each year based on the Medicare Economic Index. Section 5107 of the Deficit Reduction Act of 2005 required an exceptions process to the therapy caps for reasonable and medically necessary services. The exceptions process for the therapy caps has been continuously extended several times through subsequent legislation. Most recently, Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the therapy caps exceptions process through December 31, 2017.

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