New Medicare limits on some therapies

The federal government has set requirements that limit how much Medicare pays for outpatient therapy services per year. The Medicare benefit for outpatient physical therapy and speech-language pathology services (combined) is limited to $1,810 per year. There is a separate yearly benefit limit of $1,810 for outpatient occupational therapy.

Before the limits, you pay the coinsurance listed in your PriorityMedicare Evidence of Coverage (EOC) after you have met your yearly deductible, if applicable. After you have reached the $1,810 cap, you will be responsible for 100% of the charge, unless you have other insurance coverage. There is no cap if you go to a hospital outpatient therapy department.