Therapy cap

Therapy cap is a term used in the healthcare industry to refer to a limit on the amount of physical therapy, occupational therapy, and speech-language pathology services that a patient can receive under Medicare. This cap was originally established by the Balanced Budget Act of 1997.

History

The therapy cap was introduced as a cost-saving measure in the Balanced Budget Act of 1997. It was intended to control the costs of outpatient therapy services provided by Medicare. The cap was initially set at $1,500 per beneficiary per year for all outpatient therapy services combined.

Current Status

In 2018, the Bipartisan Budget Act permanently repealed the therapy cap. However, a threshold on physical therapy (PT) and speech-language pathology (SLP) services combined, and a separate threshold for occupational therapy (OT) services was established. If the cost of the services goes beyond the threshold, providers must add a modifier on the claim indicating that the services are medically necessary.

Impact

The therapy cap has been a controversial issue in healthcare. Supporters argue that it helps to control costs and prevent overutilization of services. However, opponents argue that it can limit access to necessary care for patients who require extensive therapy services.

See Also

• Medicare
• Physical therapy
• Occupational therapy
• Speech-language pathology
• Balanced Budget Act
• Bipartisan Budget Act