Medicare Limits on Therapy Services

From September 1, 2003 through December 7, 2003 there was a limit on the amount Medicare would pay for outpatient physical therapy, speech-language pathology and occupational therapy services. This limit was removed by the recent Medicare Prescription Drug and Modernization Act of 2003.

Effective December 8, 2003, there is no limit to the amount of medically necessary outpatient physical therapy, speech-language pathology and occupational therapy services you may get. The moratorium is effective December 8, 2003 through December 31, 2005.

We recently learned the system may have incorrectly reduced or denied payments for therapy services that should have been paid on or after December 8, 2003. We are working to identify anyone affected by this error that received a Medicare Summary Notice stating a denial for therapy services because the yearly limit had been met. If you are affected by the error you will receive another Medicare Summary Notice that will include the adjustment to your claims and reflect the proper Medicare payment.

For more information about the therapy limits that were effective September 1, 2003 through December 7, 2003, See the New Medicare Limits on Therapy Services* fact sheet.

* Denotes that you will be leaving the AdminaStar Federal Web site.