Therapy caps were first established by the Balanced Budget Act of 1997 and limit the amount of therapy services a beneficiary can receive in a year, regardless of their condition. The 2017 therapy cap limits are:
- $1,980 for physical therapy (PT) and speech-language pathology (SLP) services combined
- $1,980 for occupational therapy (OT) services
On Thursday, October 26, Congress issued a draft bill to permanently repeal therapy cap limits, which are considered to be a long-standing problem for Medicare beneficiaries and providers. The major components of the proposed policy include:
- The Part B therapy caps would be repealed beginning January 1, 2018.
- The limited targeted medical review process first established in the MACRA 2015 legislation would be made permanent beginning January 1, 2018, with the following details:
- The dollar threshold for possible medical review targeting would be set at $3,000;
- Providers would be required to submit a KX modifier at the $3,000 targeted medical review threshold; and
- The CMS funding for medical review would be fixed at the same $5 million per year levels as the prior MACRA review process.
- Congress must act before the end of the year to either repeal the therapy caps or to grant another temporary extension for the exceptions process. Since 1999, Congress has acted 17 times to suspend or modify the therapy cap process.