Helping Clear Confusion Around Medicare Caps and Speech-Generating Devices

Oct 18, 2012 | by Michele Hart-Henry
Changes — or perceived changes — to an already complex healthcare system can bring uncertainty and confusion. This is what happened recently when beneficiaries received letters from Medicare outlining payment caps for patients receiving speech therapy services.

The phones at Lingraphica started ringing — from both speech-language pathologists (SLPs) and patients — asking how this would affect reimbursement for speech-generating devices.

The short answer is that it doesn’t.

Speech-generating devices are durable medical equipment and Medicare reimburses devices separately from therapy services. Having said that, we also wanted to do some homework of our own. We are not an authority on therapy caps and we would never provide billing or therapeutic advice, but we still wanted to offer useful information to SLPs, caregivers, and patients.

What we can tell you is that Medicare caps for therapy are not new. However, there have been recent changes in the levels of the caps for different types of therapies. For 2012, the therapy cap is $1,880 per beneficiary for Speech Therapy and Physical Therapy, including deductibles and co-payments. Additionally, the caps, for the first time, extend to outpatient rehabilitation facilities owned or run in conjunction with hospitals.

The letters being sent by Medicare are also new. These letters state that the patients may be liable for therapy that exceeds the caps and is not found to be medically necessary. Although informative, the letters do not explain that there is an exceptions process for all medically necessary therapy services in excess of the cap amount. Unfortunately, we have been hearing that patients are declining therapy for fear of being held responsible for their therapy costs if the therapy exceeds the cap.

While we don’t provide therapy and our speech-generating devices are not included in the cap amounts, we have been monitoring the situation and want to relay any additional information or resources via our website and this blog.

Please visit our Lingraphica Newsroom for a more detailed explanation of the new Medicare therapy caps. Click Here.