This blog post comes from WebPT copywriters Charlotte Bohnett and Erica Cohen.

Medicare compliance is one very tough nut to crack as is navigating the murky waters of medical insurance billing. We’ve filled this month’s blogs with all sorts of valuable and applicable information on everything from HIPAA to autonomy. But what Medicare obstacles do you grapple with daily? Today, let’s talk the five most frequently asked questions regarding Medicare.

1.) What is the Therapy Cap?
According to the APTA’s FAQs on the Therapy Cap and KX Modifier, under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services through Medicare. That means that Medicare will only reimburse you as the rehabilitation therapist up to a certain dollar amount per patient regardless of services provided.

In 2012, that annual per beneficiary therapy cap is $1,880 for physical therapy and speech language pathology services combined, and there is a separate $1,880 amount allotted for occupational therapy services.

Note: While the Medicare Advantage plan may apply a $1,880 therapy cap with an exceptions process, many Medicare Advantage plans have chosen not to apply a therapy cap in the past. Please check with your Medicare Advantage plan regarding its payment policies.

Read WebPT cofounder, COO, and PT Heidi Jannenga’s take on the therapy cap in her blog post, “Save the Day the CMS Way.”