by John Yodonise

December 26, 2017

Changes in 2018 Therapy Cap

The CMS 2018 Therapy Cap Update

There are several changes in the 2018 Therapy Cap for Medicare that everyone needs to be aware of going into the New Year.


The 2018 Therapy Cap Good News

The 2018 Therapy Cap amount for physical therapy and speech language pathology services combined as well as the cap for occupational therapy will be $2,010. This represents a small increase from the 2017 Therapy Cap amount of $1,980.


The 2018 Therapy Cap Bad News

Due to the inaction of Congress, the KX modifier and the $3,700 Cap were not extended into 2018 and will no longer apply so the $2,010 Therapy Cap is a hard cap. Congress has recessed so no changes to the cap are expected before January 1, 2018 when the new cap takes effect.

So until Congress returns from its recess on January 19, 2018 and addresses the Therapy Cap exception process, the following will be in effect:

  • CMS will deny payment of any claims that exceed the $2,010 therapy cap in 2018
  • Medicare beneficiaries will be responsible for any claims that go over the cap (so make sure your patient paperwork is in order)
  • The KX modifier should not be used after January 1, 2018 for 2018 claims (until Congress addresses the issue)

The therapy cap is just one of several issues Congress left unresolved. Other critical Medicare policies that were not extended include special payments for ground ambulances, reauthorization of special needs plans, and an extension of the State Health Insurance Health Programs.

The APTA and other stakeholders have been working hard in 2017 to permanently end the cap but the legislation has been stalled in Congress. You can find more information about  APTA's response to the therapy cap 2018 issue here.

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