Therapy Cap Update as of January 23, 2018

January 23, 2018
Rick Gawenda

The United States Senate and House of Representatives have passed legislation to fund the federal government until February 8, 2018 and fund the Children’s Health Insurance Program for 6 years. President Trump signed the bill Monday evening. Unfortunately, the legislation had no language in it regarding the therapy cap, repeal of the therapy cap and/or extension of the therapy cap process for calendar year 2018. So what does this mean for Medicare beneficiaries receiving outpatient therapy services?

Currently, there is a hard therapy cap of $2010 for physical therapy and speech-language pathology services combined and a separate $2010 for occupational therapy. There is no therapy cap

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  1. So as long as we put the KX on there they will not deny? Or we don’t because there is no process and it will be denied? COnfused.

  2. So for an outpatient practice at a LTACH (long term acute care hospital), does the exception mean there should be a KX on the claim, or there is no cap at all? Thank you for your input, there is very little guidance out there.

    1. A LTACH is considered an outpatient hospital so you would be exempt from the 2018 therapy cap as I answer this on February 5, 2018.

  3. Hi Rick, Do you know when Congress will meet again or is this not known? I am going to notify my therapists of the update (I was holding off until congress met in hopes we would hear a final decision on the therapy cap process). I dont want to hold off any longer.

  4. Hi Rick,
    Should we still bill Medicare so they have record of the billing that is over the cap? I assume that if it does pass later there will a retro pay in place.

    1. If a Medicare beneficiary exceeds the therapy cap in a non-outpatient hospital setting and the hard therapy cap is still in place and you issue an ABN, it would depend on what option the Medicare beneficiary selects on whether or not you submit the claim to your Medicare Administrative Contractor.