Do Medicare Beneficiaries Have Unlimited Outpatient Therapy Benefits?

April 26, 2021
Rick Gawenda

One of my Medicare patients called the Medicare program to ask them about outpatient therapy benefits and they were told that they have unlimited outpatient therapy benefits. Is that true? Let me provide the answer to that question below with the reference to support my answer.

Do Medicare beneficiaries have unlimited outpatient therapy benefits?


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  1. As always, the information you provide to members is timely and on point. Thank you for all the research you do to educate PTs, OTs, SLPs, and billers like myself.

  2. Hi Rick,
    Thanks for your informative updates. We had a MC patient last year who we had to see twice over a 7- month period. The first time was for LBP w/sciatica in left LE with good resolution. A few months later his condition got worse & he had to have a laminectomy. We used the KX modifier after he passed the threshold but MC stopped paying after he passed the $3,000 mark. What does a clinic do in this case to get paid for the denied visits past $3k?
    I appreciate your detailed advice for this issue.

    1. You would have to look at the denial reason from your Medicare contractor and then proceed from there.