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naturelady1048 Asked October 2015

$1940 cap for PT how do they reach this amount?

They add the payments they made, but do they also add the part B deductible even with Fplan? I have had 15 sessions of physical therapy for my knee. The medicare cap for this year is $1940.00 Now I need PT for my shoulder. I have no idea how they figured the amount I have for PT on my statements. I can not figure it out. I know that they use the dollar amount they paid, but do they also count the part B deductible of $147.00. I have the F plan for a supplemental and they paid this deductible. I know that I will speak to medicare myself, however I thought that someone else could advise me before I do.
Thank you for any help.

tvidos Oct 2015
I went to medicare.gov $1940 for PT & Speech $1940 totalling $3700
$1940 for Occupational Therapy also
However, claims there can be an exception with proper documentation that it is medically necessary by therapist
My Mom has exhausted Part A at Nursing Home so now they are going to do Part B She still isn't walking good & is more wheelchair bound So before I move her to Assisted Living they are trying to get in about 5-6 times PT-Part B
which that many days isn't going to get her where she needs to be. We're applying for Home Health so she can continue to get PT with the hope that she will make more progress than she is now. They've (PT) had over 60 days (2 months) since her last fall breaking her leg femur the 2nd time. She was over medicated & the dr/nurse just took a really long time to fix that so some days she really couldn't do much & all they did was wear her out. Then, she doesn't want to do anything but sleep. Very sad.

sscoale Oct 2015
The Medicare cap has really been devastating to the elderly who need speech therapy, OT and/or PT. When Mom's PT visits expired, we found a personal training and group exercise classes with this trainer - who has ended up being more effective and providing mom more socialization and physical assistance than she received from formal PT in the rehab center.

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pamstegma Oct 2015
Medicare.gov does put the cap at $1940 for 2015, but you should ask for an exception to the rule, since this is PT on a different part of the body.

JoAnn29 Oct 2015
1940 doesn't seem much. Call the therapy billing office and ask them to explain. Also, you should get a statement from Medicare and one from your supplimental. On the supplimental it should show what Medicare paid and what they paid. Both should show if you met the cap and deductables.

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