The following appeared in the September2, 2003, issue of Dear Marci, a FREE online newsletter from The Medicare Rights Center.
Q: I am currently receiving physical therapy for surgery I had a few months ago. My therapist is concerned about the number of visits I am entitled to. She says Medicare is setting a limit. I'm a little confused and would appreciate more information on this limit and how it'll affect my treatment costs. Thanks. — Walter (Brattleboro, VT)
A: Effective September 1, 2003, Medicare is limiting how much it pays for outpatient physical therapy (PT), speech-language pathology (SLP) and occupational therapy (OT). The therapy caps are $1,590 each calendar year for PT and SLP combined, and an additional $1,590 each calendar year for OT. (In 2003, the limit will only apply to the four months beginning September.) After you pay the Part B deductible, Medicare will cover 80% of the $1,590 limit ($1,272). Once the limit has been reached, you must pay the full cost of the services until January 1st of the following year. Advocates, led by the Medicare Rights Center, are currently working to delay or repeal the cap, so stay tuned for updates.
The therapy limits apply to outpatient therapy received at:
- therapists' or physicians' offices;
- outpatient rehabilitation facilities;
- skilled nursing facilities for outpatients or residents who do not have Medicare-covered stays; and
- home, through therapists connected with home health agencies, when not part of a Medicare-covered home health benefit.
The limits do not apply to outpatient therapy you get at hospital outpatient departments, unless you get it from the hospital's Medicare-certified skilled nursing facility. Any outpatient therapy you receive before August 31, 2003, will not count towards your 2003 limit.
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The Medicare Rights Center (MRC) is a national, not-for-profit consumer service organization working to ensure that older adults and people with disabilities receive high-quality, affordable health care. For more information about MRC, visit the web site http://www.medicarerights.org or write to The Medicare Rights Center, 1460 Broadway, 11th Floor, New York, NY 10036.
December 2003
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