Is there a limit to the amount of outpatient physical, speech-language, or occupational therapy services that you can get?
Is there a limit to the amount of medically necessary outpatient physical therapy, speech-language pathology, or occupational therapy services that you can get?
Medicare helps out pay for medically required outpatient physical and occupational therapy and speech-language pathology services when:
- Your doctor or therapist sets up the plan of treatment, and
- Your doctor periodically assesses the plan to observe how long you will get the therapy.
You can obtain outpatient services from a Medicare-approved outpatient provider such as a participating hospital or skilled nursing facility, or from a participating home health agency, rehabilitation agency, or a comprehensive outpatient rehabilitation facility. Moreover, you can get services from a Medicare-approved physical or occupational therapist, in private practice, in his or her office, or in your house. (Medicare doesn’t pay for services given by a speech-language pathologist in private practice.)
Medicare is required to limit how much it pays for outpatient therapy services for every year. This is called an annual financial limitation, or cap. Your Medicare benefit for outpatient physical therapy and speech-language pathology services (combined) is limited to $1780 every year. There is a separate yearly benefit limit of $1780 for outpatient occupational therapy.
Medicare Part B pays for Occupational, Physical, and Speech therapy as long as it is medically essential, but only up to the yearly benefit limit of $1780. Prior to the limits, you pay 20% of the Medicare-approved amount once you have met your yearly deductible. After you have reached the $1780 cap, you will be liable for 100% of the charge, unless you have other insurance coverage.
There is no cap if you go to a hospital outpatient therapy department. People who occupy a Medicare-certified bed in a skilled nursing facility are limited to the cap amounts and cannot obtain additional covered outpatient hospital therapy while in the certified bed.
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