medicare coverage for therapy

Post date: Nov 13, 2014 12:34:03 PM

Watch your number of visits allowed annually (16), $ coverage limit, and weigh the impact if voice and physical therapy are combined together for annual amount covered, will that meet your needs. Also be aware of in-hospital or rehab setting versus other location options.

Medicare & Parkinson’s Disease: Therapy Caps & the Exceptions Process

Medicare Therapy Caps and the Exceptions Process

• There is currently a combined $1,920 yearly cap for physical therapy and speech-language therapy, and a separate $1,920 yearly cap for occupational therapy.
• In 2006, Congress created an exceptions process for services deemed medically necessary to serve Medicare beneficiaries who need therapy services beyond the cap. As of now, the exceptions process is available until March 2015.
  • Communicating the Exceptions Process to Therapists
• If care continues to be medically necessary beyond either $1,920-cap level, the therapist must apply a KX modifier to the therapy code to show the use of the therapy cap exceptions process.
• Documentation, provided by the therapist, must also be detailed and support the medical necessity of continuing therapy. Documentation to support medical necessity also is important when a patient reaches $3,700 in annual spending as Medicare will review each claim above this threshold to determine if care can continue.
• The documentation should indicate why the patient requires continued skilled therapy as the absence of this information may result in Medicare’s decision to deny claims for these services.
  • For more information about the history of the exceptions process, PAN’s push for a repeal, and what you can do, visit www.parkinsonsaction.org/medicaretherapy.
  • http://www.lsvtglobal.com/news/press-releases/lsvt-global-expert-clinicians-address-medicare-therapy-cap

• Lately, we have received many inquiries and expressions of concern regarding the Medicare therapy cap that is being placed on treatment received within outpatient hospital settings. Specifically the cap notes that Medicare will cover $1880 (now $1,920.00) per calendar year for combined Speech Language Pathology (SLP) and Physical Therapy (PT) services. Occupational Therapy (OT) services covered by Medicare are capped at $1880 per calendar year. First, we encourage clinicians to remember that this cap applies only to Medicare patients at this time, and there are a number of patients who have secondary and tertiary insurances besides Medicare.