Physical Therapy Caps on Medicare Advantage

Apr 1, 2016

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  1. Piece Of The Pie
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    Piece Of The Pie Super Genius

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    Do Medicare Advantage Plans follow the same dollar limits as Original Medicare when it comes to Physical Therapy? I have searched the Evidence of Coverage of 2 Advantage Plans and there is no mention of any caps.

    Here is an excerpt from Medicare...Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical and occupational therapy, and speech-language pathology services. There are limits on these services when you get them from most outpatient providers. These limits are called “therapy caps” or "therapy cap limits."

    The therapy cap limits for 2016 are:

    $1,960 for physical therapy (PT) and speech-language pathology (SLP) services combined

    Thanks in advance.
     
  2. j10
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    j10 Expert

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    if its not in the evidence of coverage id assume there's no cap as long as the MAPD's claims dept continues to agree with the prescription
     
    j10, Apr 1, 2016
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  3. yogooglethis
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    yogooglethis Guru

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    The MA EOC doesn't spell out there is no lifetime maximum benefit or that there is a 1,960 annual PT cap because it mirrors original medicare.MA benefits/amounts allowed are the same as original medicare UNLESS it is specifically detailed in the EOC .Of course the only time it can be different is if it's better .i.e unlimited IP hospital days vs. original medicare 90 day IP benefit period.
     
  4. Piece Of The Pie
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    Perfect, thanks.
     
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