November 20, 2012

Medicare sets cap for hospital therapy services


---- — PLATTSBURGH — Medicare is now limiting the amount of therapy patients can receive at some area hospitals.

The Centers for Medicare and Medicaid Services has initiated a therapy cap for outpatient services in physical, occupations and speech therapies, but patients can seek an exception to the cap if they receive treatment that is deemed medically necessary.

“We’re starting to get a sense that people are choosing not to have therapy because of the cap,” said Christine Meister, director of Rehabilitation Services at CVPH Medical Center in Plattsburgh. “We want patients to understand that if therapy is medically necessary, Medicare will continue to pay.”

The cap for therapy services, which was already in place for private therapy offices but was expanded to hospitals in October, is set at $1,800 for physical and speech therapies and another $1,800 for occupational therapy.

Critical-access hospitals, such as Elizabethtown Community Hospital, are not subject to the cap, said Jane Hooper, director of communications for E’town.

“Obviously, that may change as health-care changes take effect,” she said. “Through its documentation and patient evaluation processes, ECH always tries to ensure that Medicare will support the physician’s and therapist’s decision to continue therapy for patients.”

“We always try to balance our therapy services with a patient’s medical needs, offering services that are medically necessary and relevant to the patient’s condition,” added William Doherty, director of the Physical Therapy and Rehab Department at ECH.


Meanwhile, hospitals like CVPH will continue to work with patients to determine if they remain eligible for therapy despite the cap.

“People with complex illnesses or injuries who need more therapy may be exempt from the cap if we can determine that more therapy is medically necessary,” Meister said. “If patients come in (for an assessment of therapy needs), we can make that determination.”

For instance, if a person suffered a leg injury earlier this year and completed several weeks of physical or occupational therapy as an outpatient at an area hospital, that person may be approaching his or her therapy cap.

If that same person were to suffer another injury today, hospital therapists could determine how close the patient is to the cap and whether the new injury qualifies for the exemption.

“People are guaranteed payment by Medicare for that evaluation,” Meister said. “In order for us to help the patient, we need to make that initial evaluation.

“It all has to do with what would be the impact if a person did not have therapy,” she added. “Would it have a negative impact on the person’s ability to perform normal daily activities.”

The therapy cap is for services provided in 2012. Meister does not know if the cap will continue in 2013 but noted that Medicare continues to look for ways to reduce the costs of providing health care.

Email Jeff Meyers:



For more information on the new Medicare caps for outpatient therapy at hospitals, visit or call (800) 633-4227.

Personal Medicare information can also be accessed through Medicare's secure server at Rehab patients at CVPH can call 562-4616 for more information.