The Medicare therapy caps went into effect on January 1, 2013 limiting Medicare coverage on outpatient rehabilitation services to what is now $1,900 for physical therapy and speech therapy combined and $1,900 for occupational therapy. The recently enacted budget legislation leaves unchanged from current Medicare law the structure of these two $1,900 therapy caps.
The exception process allows a significant number of Medicare patients to receive services exceeding the $1,900 annual financial cap on Medicare therapy coverage. The exception process is set to expire on December 31, 2013. Without additional action, these arbitrary caps will again limit a significant amount of Medicare beneficiaries from receiving the necessary physical therapy treatment or forcing them to pay for these services 100% out of pocket. Please use the links below to contact your legislators and help end these arbitrary caps.
The Medicare Access to Rehabilitation Services Act (S 46/HR 43) introduced by Senators John Ensign (R-NV), Blanche Lincoln (D-AR), Susan Collins (R-ME), and Ben Cardin (D-MD), and Representatives Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO) calls for the repeal of the Medicare therapy caps that limit coverage of outpatient rehabilitation services to $1,900 for physical therapy and speech language pathology combined and $1,900 for occupational therapy services.
Visit the APTA's Cap Resource Center
Congressional Support Still Needed For Repealing the Cap
While the recently passed legislation recognizes the need for care above the cap, it will expire in December 31, 2009. Congress is likely to consider Medicare legislation again in 2009, and APTA is continuing to lobby for a full repeal of the therapy caps. It is important to continue building congressional support for legislation to completely repeal the therapy caps.