If you have had recent surgery for a hip replacement, or a stroke, you will probably need outpatient physical therapy, occupational therapy, or speech-language pathology services. When you are enrolled in outpatient care, be sure you know the limits of how much Medicare will pay.
Medicare helps pay for a portion of medically-necessary outpatient physical and occupation therapy, and speech-language pathology services, but there are limits. Those limits to your coverage are called “therapy caps.” The therapy caps for 2014 are:
- $1,920 for physical therapy (PT) and speech-language pathology (SLP) services combined
- $1,920 for occupational therapy (OT) services
You may qualify for exceptions that allow Medicare to continue to pay its share for your services after you have reached the therapy cap limits. Your therapist must document in your medical record your need for continued medically-necessary services, and your therapist’s billing office must indicate on your claim that additional outpatient therapy services above the therapy cap limits are medically necessary.