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Medicare and PT/OT: the give and the take.

As of January 1, 2006, Medicare put a combined spending cap of $1,740 annually on outpatient physical therapy (PT) and speech-language services and a separate $1,740 yearly limit for occupational therapy (OT). Then in February, the Centers for Medicare and Medicaid Services (CMS) created a process to allow exceptions to the caps for certain conditions.

The good news is that MS is listed as an automatic exception. This means that PT, speech therapy, and OT services can go over the $1,740 limit. No written request or appeal is required.

The not so good news: The cap exception is valid for 2006 only. Unless Congress takes action, the therapy limits will be back for 2007. Legislation has been submitted to abolish the cap. The Society will keep you posted.

NOTE: The cap exception is retroactive to the beginning of 2006. Any claims to Medicare for PT/OT denied early in the year can be resubmitted.
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Publication:Inside MS
Date:Jun 1, 2006
Words:157
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