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Advising the Congress on Medicare issues
MedPAC > Recommendations > Mandated report: Improving Medicare’s payment system for outpatient therapy services (2)

Mandated report: Improving Medicare’s payment system for outpatient therapy services (2)

June 14, 2013

To avoid caps without exceptions, the Congress should:

  • reduce the therapy cap for physical therapy and speech-language pathology services combined and the separate cap for occupational therapy to $1,270 in 2013. These caps should be updated each year by the Medicare Economic Index.
  • direct the Secretary to implement a manual review process for requests to exceed cap amounts, and provide the resources to CMS for this purpose.
  • permanently include services delivered in hospital outpatient departments under therapy caps.
  • apply a multiple procedure payment reduction of 50 percent to the practice expense portion of outpatient therapy services provided to the same patient on the same day.

Topics: Ambulatory care settings, Beneficiaries and coverage, and Physicians and other health professionals.