Medicare Therapy Caps Repealed!

man doing physical therapy with exercise ball and band

Medicare Part B covers medically necessary physical therapy and speech language pathology. For two decades, there has been a cap on the amount covered for these services under Medicare. For 2018, the cap was to be $2,010 for physical therapy and speech language pathology services combined and $2,010 for occupational therapy services.

But there is good news. The Bipartisan Budget Act of 2018 included a permanent repeal of the Medicare therapy caps starting January 1, 2018.  

Medicare therapy caps repealed

Why is the repeal important?

Margaret Danilovich, physical therapist and public health researcher at Northwestern University, argued that the therapy cap was costly in the long run to patients’ health. For example, someone with one or more chronic illnesses would need ongoing PT to maintain their health, prevent scar tissue from building up, and to be mobile.

Under 2017’s therapy cap, the dollar amount covered about two months of therapy, which is not nearly enough in some cases, especially for those dealing with Parkinson’s, Alzheimer’sstroke, hip fracture, arthritis, MS, or major injury recovery. Physical therapy rehab allows Medicare beneficiaries to continue to live independently at home rather than moving into a nursing home, or worse, undergoing costly hospitalizations.

Relief for those with chronic illness

Over time, other rules regarding therapy caps have changed. Effective January 7, 2014, Medicare beneficiaries can no longer be denied coverage for physical, occupational, or speech therapy simply due to lack of improvement – a decision that greatly benefits those with Parkinson’s, Alzheimer’s, and other chronic conditions.

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