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Orthopedic Coding Alert

READER QUESTIONS:

Therapy Cap Looms for Medicare Claims

Published on Sun Jan 01, 2006

Question: Are our therapy claims going to be subject to the PT cap again soon? We thought we were still under the moratorium, but our office manager thinks otherwise.


Wisconsin Subscriber


Answer: Unless Congress extended the moratorium after Orthopedic Coding Alert-s press time, you are once again subject to the therapy cap as of Jan. 1. (As of press time, the Senate had voted to extend the cap's moratorium, but the House had not yet acted one way or the other.)

Medicare will now limit therapists in private practice to $1,740 in reimbursement per beneficiary. If patients need additional therapy after exceeding that cap, they will either have to forgo the treatment or have to pay for it 100 percent out of pocket.

You can learn more about the therapy cap at the American Physical Therapy Association's Web site, www.apta.org.
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