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Therapy Cap Values for Calendar Year (CY) 2017

4 Nov 2016 1:55 PM | Zachary Edgar (Administrator)

November 4, 2016

Effective Date: January 1, 2017

Background: The Balanced Budget Act of 1997, P.L. 105-33, Section 4541(c) applies, per beneficiary, annual financial limitations on expenses considered incurred for outpatient therapy services under Medicare Part B, commonly referred to as “therapy caps.” The therapy caps are updated each year based on the Medicare Economic Index. An exceptions process to the therapy caps for reasonable and medically necessary services was required by section 5107 of the Deficit Reduction Act of 2005. The exceptions process for the therapy caps has been continuously extended several times through subsequent legislation. Most recently, section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the therapy caps exceptions process through December 31, 2017.

Policy: Contractors shall update the allowed dollar amount for CY 2017 outpatient therapy limits to $1,980 for physical therapy and speech-language pathology combined and $1,980 for occupational therapy

Reference

Medicare Transmittal # R3644CP

November 4, 2016


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