CY 2015 Therapy Cap Values Announced

Therapy Cap CR to 100-04

Pub. 100-04

Transmittal: 3120

Date: November 14, 2014

Change Request: 8970

SUBJECT: Therapy Cap Values for Calendar Year (CY) 2015 

EFFECTIVE DATE: January 1, 2015 

*Unless otherwise specified, the effective date is the date of service. 

IMPLEMENTATION DATE: January 5, 2015 

I. GENERAL INFORMATION 

A. 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 103 of the Protecting Access to Medicare Act of 2014 extended the therapy caps exceptions process through March 31, 2015. 

B. Policy: Therapy caps for CY 2015 will be $1,940. 

Contractors shall update the allowed dollar amount for CY 2015 outpatient therapy limits to $1,940 for physical therapy and speech-language pathology combined and $1,940 for occupational therapy.