Medicare now enforcing the hard cap of $2010 for Physical, Speech-Language and Occupational Therapy

S

Sharon S. Campbell

New Member
Hi, everyone. I'm new to this forum and I joined to help get news out about Medicare changes. This first post is about Congress not yet passing continuing legislation to ensure doctors can extend the basic Medicare coverage of: 1) $2,010 for physical therapy (PT) and speech-language pathology (SLP) services combined, and 2) $2,010 for occupational therapy (OT) services.

The continuing legislation ended Dec. 31, 2017 and because of that, providers can no longer extend these therapies due to medical necessity (previously up to $3,700 for 1) and $3,700 for 2)).

So, currently/until Congress passes new legislation to again allow doctors to extend this coverage when needed, you and I would be 100% responsible for any costs over $2,010, as stated above. Medicare will not approve and cover these additional costs.

I was very surprised to find out about this and I don't even know if my doctor's office knows (where I had PT through the end of 2017 and stopped shortly into 2018, so it didn't come up for me but the therapist was answering my questions as if treatment could be continued if medically necessary).

You may want to contact your Congressional representative and federal Senators. Make no mistake, this is not theI only thing that is under attack within Medicare...much more is at stake, but, for now, this is enough to think about.

I hope this is helpful to many of you.

Be well,
Sharon S. Campbell, Author "Medicare Enrollment Personal Workbook" (new edition planned for late February)
 

Medicare cut my mother off years ago for therapy despite the fact that she was improving after a stroke.

On the other hand, this is what we can expect from government (taxpayer) funded insurance. For those of you hoping for single payer this may be our fate.

Rick
 
Hi, Rick: Sorry to hear about your Mom. The extension of rehab services does eventually have an annual cap in Medicare, however, it's been my experience (and via research) that that is the case for virtually any insurance, although some with larger companies and governments may have more coverage. Healthcare coverage is not very good in this country altogether.

Be well,
Sharon
 

I know someone who has needed home pt, ot and nursing several times over the last couple of years. They said unless it's absolute necessity they don't want to see it run over 30 days and/or a set number of visits. In other words one has to use the allocated number of visits with in that time. So after 30 days or visits used up the patient is done.

Home nursing "might" be easier to get in some plans because they say in many cases where no treatment is required in a hospital or medical setting insurance wants home care. No more observation type stays. Once a patient is done with actual treatment they are supposed to be discharged. As soon as the patient can function at home they are supposed to be discharged. Fitness and functionality are two different things. I've seen surprising results from 80 year olds that never worked out but they will only do it when pushed by and pt or ot. Instead of these useless home nurse visits/quick cheap physical the insurance companies need to emphasize physical therapy and exercise as much as medical treatment and solutions.
 
Thank you for the heads up Sharon. Are those caps per year? I would hope so. I had physical therapy for an knee problem years ago before I was medicare eligible. I believe my insurance (Aetna HMO) only paid for 11 visits. I had a co-pay. Blessedly the therapy was something I could continue to on my own (stationary bike and other at home exercises).
 
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