What is the Medicare Therapy Cap and how does it affect my treatment?
The Medicare Therapy Cap is a dollar amount per year that each patient is limited to with outpatient physical therapy coverage. The beneficiary must first cover the Medicare deductible, and pay 20% co-insurance, and Medicare will cover the remaining 80%, up to $1840, for 2009. (Medicare’s 80% is equal to $1472 and the patient’s 20% makes up the remainder, $368.) Once that cap is reached, should you agree with your therapist and doctor that it is medically necessary for you to continue treatment, our receptionist will ask you to sign an ABN (Advance Beneficiary Notice). The ABN notifies you that you will be financially responsible for these services. Your therapist can give you more information and discuss this with you at the time, as there are certain diagnoses that qualify for an exception to the cap. Congress passed legislation in July 2008 to extend the therapy cap for another 18 months to ensure access to physical, occupational and speech therapy for those patient needing care abo
