Therapy Above $3700 for Medicare Patient’s

Question

We have a patient that is coming to us that received Speech Therapy in another facility which used his PT/Speech Medicare benefits to the point of the therapy cap dollar threshold and has since discharged him. He now has started coming to our clinic for shoulder rehab under his Medicare benefits; however, we are having to KX the charges so we can get paid and provide the necessary care to improve his ROM, strength, and function. Since we do not desire to use up ALL of his PT benefits (to the point of $3700 total) in case he should experience another incident before the end of the year, we were discussing the possibility of transferring him to OT for continued shoulder rehab. His OT benefits have only been partially used and he still has ample benefits under OT that would allow him to receive therapy without having to KX or exhaust his benefits. Would this create a problem with Medicare if we were to transfer the patient to OT for the same diagnosis requiring shoulder rehab?

Answer