Orthopedic Coding Alert

Effective Sept. 1, CMS will implement a $1,590 annual cap on Medicare Part B outpatient occupational therapy and a separate $1,590 combined cap for physical therapy and speech-language pathology services.
 
Medicare beneficiaries will now be entitled to only $1,590 in outpatient therapy benefits, after which the patients will be responsible for "100 percent of therapy costs ... unless additional services are furnished directly or under arrangement by a hospital," according to the May 23 CMS Transmittal AB-03-073.
 
Medicare placed a moratorium on a previous $1,500 therapy services cap in 2000. The moratorium temporarily allowed higher outpatient therapy reimbursement limits. CMS later scheduled the new cap to take effect on July 1, but postponed it until Sept. 1, at which point outpatient therapy services performed by physicians, therapists, nurse practitioners, physician assistants and other outpatient practitioners will all be subject to the cap.
 
Excluded from the cap are outpatient therapy services "provided by a hospital to an outpatient or inpatient who has exhausted Part A benefits, and other entities who have arrangements with the hospital to provide the same services to the same beneficiaries," according to the transmittal. Also excluded from the cap are skilled-nursing facility residents covered under a Part A stay.