CMS Announces Medicare Part A & B Deductibles for 2018

November 20, 2017
Rick Gawenda

The Centers for Medicare and Medicaid Services has announced the Part A & B deductible amounts for calendar year 2018. The Part B deductible does have an impact on outpatient therapy services and how the dollar amount is calculated towards the annual outpatient therapy cap dollar threshold. In this article, I will answer the following questions:

  1. What is the therapy cap dollar amount for 2018?
  2. What is the Medicare Part B deductible for 2018?
  3. How does the Part B deductible impact the 2018 therapy cap dollar amount?
  4. What is the Medicare Part A deductible and co-insurance for hospital and skilled nursing facility admissions in 2018?

Lets answer the first question. The therapy cap dollar amount for 2018 for physical therapy (PT) and speech-language pathology (SLP) services combined is

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  1. As I understand it, the exceptions process has not been extended as of yet – meaning, of course, that we cannot “KX” after the $2010 at this time. Is that still correct?

  2. Hi Rick,
    After reading one of your previous articles, I thought the cap changes for 2018 were not going to allow for further visits after reaching the cap. Has that changed, and additional funds will be available after the $2,010, if the KX modifier is applied?

    1. As of today, November 22, 2017, that is correct. However, I am certain that will change. There are 2 articles you will want to read. The first is the current status of therapy cap and exception process for 2018.

      The second is regarding proposed legislation to repeal the therapy cap in 2018.

  3. Rick

    Can you clarify…..if you see a pt. within a critical access hospital (CAH), do you need to track the CAP dollar amounts as you do in a traditional OP setting? I understand that if the pt. transfers from the CAH to a traditional OP site, the dollars used count towards the OP site CAP. Also, do you have any resources with regards to any type of CAP within Cardiac Care?

    1. The therapy cap does apply to CAH and you would need to track the amount used for PT and SLP combined and separately for OT. I do not focus on cardiac rehab.

  4. Hi Rick!
    For this new year 2018 the CPT 97532 was deleted and replaced for G0515 for Medicare or 97127 for non-medicare payers. My question is, can I billed as an SLP the CPT code 97127 with 92507 on the same day, for the same patient, and by the same provider? Looking forward to your response. Thank you

    1. Answer is no and I will be releasing an article on this as well as 92507 and 97533 on the same day in the next 2 weeks.