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Release Date: July 27, 2012
Medicare will cover outpatient physical and occupational therapy, as well as speech therapy services, if:
- They are medically necessary;
- Your doctor or therapist sets up the plan of treatment; and
- Your doctor periodically reviews the plan to determine how long you will need therapy.
Generally, Medicare will only cover therapy services if your condition can improve or if your condition would deteriorate without therapy.
You can access therapy services as an outpatient of a participating hospital, rehabilitation agency, comprehensive outpatient rehabilitation facility or public health agency. If you qualify for home health benefits, you can access therapy services from your home health care agency, and if you qualify for skilled nursing facility (SNF) benefits, you can access therapy services from your SNF. You may also be able to receive services from a privately-practicing and Medicare-approved physical, speech or occupational therapist in his or her office or in your home.
In 2012, Medicare will cover up to $1,880 for physical and speech therapy combined, and an additional $1,880 for occupational therapy. If you are approaching the limit and need more therapy, your doctor can request additional therapy. If Medicare denies the claim, you can appeal.
For more information about therapy services, please contact the Sussex County Division of Senior Services at 973-579-0555 Ext. 1223.