Is there a limit to the amount of outpatient physical, speech-language, or occupational therapy services that I can get?

September 20, 2009 by admin

Medicare helps pay for medically necessary outpatient physical and occupational therapy and speech-language pathology services when:

• Your doctor or therapist sets up the plan of treatment, and
• Your doctor periodically reviews the plan to see how long you will get therapy.

You can get outpatient services from a participating hospital or skilled nursing facility, or from a participating home health agency, rehabilitation agency, or public health agency. Also, you can get services from a Medicare-approved physical or occupational therapist, in private practice while in his or her office or in your home. Medicare doesn't pay for services given by a speech pathologist in private practice. You can get these services from any Medicare-approved outpatient provider. Medicare is required to limit how much it pays for outpatient therapy services per year. This is called an annual financial limitation, or cap. Your Medicare benefit for outpatient physical therapy and speech-language pathology services (combined) is limited to $1840 per year. There is a separate yearly benefit limit of $1840 for outpatient occupational therapy. Medicare Part B pays for Occupational, Physical, and Speech therapy as long as it is medically necessary, but only up to the yearly benefit limit of $1840. Before the limits, you pay 20% of the Medicare-approved amount after you have met your yearly deductible. After you have reached the $1840 cap, you will be responsible for 100% of the charge, unless you have other insurance coverage. There is no cap if you go to a hospital outpatient therapy department. People who occupy a Medicare-certified bed in a skilled nursing facility are limited to the cap amounts and cannot receive additional covered outpatient hospital therapy while in the certified bed.