Medicare Limits on Therapy Services 

Medicare limits how much it covers for medically-necessary outpatient physical 

therapy, speech-language pathology, and occupational therapy. 

What are the outpatient therapy limits for 2011? 

• $1,870 for physical therapy and speech language pathology combined

• $1,870 for occupational therapy 

After you pay your yearly deductible for Medicare Part B (Medical Insurance),

Medicare pays its share (80%), and you pay your share (20%) of the therapy cost.

The Part B deductible is $162 for 2011. Medicare will keep paying its share for

therapy services until the total amount paid, including the deductible and

coinsurance, reaches the therapy limit. You may qualify for an exception to the

therapy limits (which would allow Medicare to pay for services after you reach the

limits) if the services are medically necessary. You’ll find more information about

this on the next page.

The therapy limits apply when BOTH of the following are true: 

You get outpatient therapy from any of these people

• Doctors • Speech-language pathologists 

• Physical therapists • Nurse practitioners

• Occupational therapists • Clinical nurse specialists 

• Physician assistants • Physical therapy assistants or occupational

therapy assistants under the supervision of a

physical therapist or occupational therapist AND

You get outpatient therapy at any of these places

• Most medical offices • Skilled nursing facilities (SNFs) for

• Outpatient rehabilitation outpatients or residents who aren’t in

facilities/rehabilitation agencies Medicare-certified parts of the facility

• Comprehensive outpatient • Home, from certain therapy providers

rehabilitation facilities

The outpatient therapy limits don’t apply to therapy services you get at hospital

outpatient departments or hospital emergency rooms. There is no limit on

Medicare payments for medically-necessary outpatient therapy services if you get

these services in a hospital outpatient department or a hospital emergency room. 

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CENTERS FOR MEDICARE & MEDICAID SERVICES 
CMS Product No. 10988 

Revised February 2011 

What can I do if I need services that will go above the outpatient

therapy limits? 

You don’t have to submit a written request to get an exception. However, your

therapist must keep information in your medical record to justify the need for

services beyond the therapy limits. If your need for therapy is documented and your

costs are above the therapy limits, your therapist’s billing office will add an

explanation to the claim to justify your continuing need for services. 

How do I find out if my therapy services will go above the limits?

If you get all your therapy in the same place, your therapist’s billing office will have

the most up-to-date information and will know if your services will go above these

limits. You can also check your Medicare Summary Notice. This is the notice you

get in the mail (usually every 3 months) that lists the services you had and the

amount you may be billed. You can also visit www.MyMedicare.gov to track your

claims for therapy services. This Web site is Medicare’s secure online service for

accessing your personal Medicare information. 

Where can I get more information? 

Call your State Health Insurance Assistance Program (SHIP) to get free personalized

health insurance counseling. To get the phone number for your state, call 

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. 

You can also visit www.medicare.gov/contacts.

Note: This information only applies if you have Original Medicare. If you get your

Medicare health care through a Medicare Advantage Plan (like an HMO or PPO),

check with your plan for information about your plan’s coverage rules.

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