Latest Developments
ALERT: Therapy Caps Resume July 1, 2008
CMS has announced that the therapy cap exceptions process will no longer be recognized as of July 1. Read more.
Resources for Checking Client Accrual of Therapy Services Toward Cap
- Common Working File (CWF) users, check "applied" amount [PDF]. See CR4115.
- HIPAA Eligibility Transaction System (HETS) 270/271 users, check "remaining" amount [PDF]. See the page 18.
- Medicare contractors' Interactive Voice Response units (IVR) return either the remaining or applied amounts based upon contractor programming.
- For additional information, Providers and Suppliers should also read the Medicare Claims Processing Manual [PDF]. See chapter 5, section 10.2.
Background on Therapy Caps
The Medicare cap on outpatient rehabilitation therapy services was originally instituted under the Balanced Budget Act of 1997 as a combined cap on speech-language pathology (SLP) and physical therapy (PT) services, as well as a separate cap on occupational therapy (OT) services to Medicare beneficiaries.
The original $1500 cap on Part B Medicare therapy services was intended as a cost control mechanism, but has not proved effective in saving Medicare money. Instead, it has punished the sickest of Medicare patients and denied them needed care. Congress has recognized that a financial limitation on therapy is detrimental to Medicare patients and through the years placed numerous moratoriums on its implementation. In December 2007, the President signed the Medicare, Medicaid, and SCHIP Extension Act of 2007 into law. The law directed CMS to continue to allow exceptions to therapy caps for certain medically necessary services provided on or after January 1, 2008 through June 30, 2008.
Additional Resources
Archives - ASHA's previous advocacy efforts on the Medicare Therapy Cap Advocacy Campaign
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