Therapy services: Medicare limits the amount of coverage you can get as an outpatient for physical or occupational therapy and speech-language pathology in any given year. In 2009 the limits are $1,840 for occupational therapy and $1,840 for physical therapy and speech-language pathology combined. These dollar limits are the total cost of the services received in a year—including what Medicare pays, what you pay (20 percent of the Medicare-approved amount) and your Part B annual deductible ($135 in 2009) if this applies. Here are exceptions:
• Medicare may continue to cover these services, beyond the annual limits, if you have a condition that requires ongoing therapy, such as extensive rehabilitation for stroke and heart disease. To get this exception, your therapist must justify the need when he or she bills Medicare.
• There are no limits on medically necessary therapy that you get at a hospital outpatient department or emergency room.
If your therapy exceeds the limits, and you don’t qualify for an exception, you can continue to get Medicare coverage if you’re able to switch to hospital outpatient or emergency services. Otherwise, you’re responsible for the full cost for the rest of the year.
Patricia Barry is a senior editor at the AARP Bulletin.