United States

Senior Living Health Care Connection: Part B therapy caps repealed


The therapy cap on Medicare Part B therapy services has finally been repealed as of Feb. 9, 2018. Congress enacted a permanent end to the extension process that has been ongoing for 20 years since passage of the Balanced Budget Act of 1997. Claims for services beginning Jan. 1, 2018 can now be submitted. The advanced beneficiary notice needed prior to the repeal is no longer needed when the services go over the caps. Therapists can provide the necessary physical, occupational and speech-language services to Medicare beneficiaries without regard to the caps. However, providers are still required to add the KX modifiers for claims that go over $2,010 for physical therapy and speech-language services and $2,010 for occupational therapy. The KX modifier attests that the services were medically necessary. Claims that go over the $3,000 threshold for physical and speech therapy and the $3,000 threshold for occupational therapy are now subject to a targeted medical review. This is a change from the $3,700 threshold.

Additionally, Congress included an 85 percent payment differential for physical therapist assistants and occupational therapy assistants as compared to the billing codes now priced for physical therapists and occupational therapists. This is scheduled to be enacted in 2022 but there is hope that this will be addressed and changed over the course of the years prior to the anticipated enactment date.

For more information, contact Joan McCarthy at +1 312 634 3479.