Annual per-beneficiary Part B payment limitations (caps) were extended to Medicare’s coverage of therapies (physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services) in facilities, including skilled nursing facilities in 1999. The therapy caps limit payments for services irrespective of clinical need or outcomes. The cap limits apply to services received in all health care settings furnishing Part B therapy services (SNF, hospital, a therapist's or physician’s office, a home health agency, or a rehabilitation agency). That means, services received before the patient was seen in the SNF during the current year count towards the cap. Today’s therapy cap is $1,940 for PT/SLP combined. OT has a separate $1,940 cap limit. The cap threshold limits are adjusted annually.
However, Congress established an exceptions process in 2006 to permit medically necessary services beyond the cap limit as long as the therapist attests to the medical necessity and certain coding requirements are met. The exceptions process was recently extended by Congress through December 31, 2017.