Advocacy Action Center: Act Now: Urge Congress to Immediately Repeal the Medicare Part B Outpatient Therapy Caps

Members & Publications


January 15, 2018

On January 1, 2018, therapy cap restrictions on Medicare Part B outpatient services went into effect, after a December 31 expiration of the current exceptions process. The Medicare therapy cap is an annual limit on per-patient therapy expenditures under Part B. As a result, many of your patients are now at risk of losing access to this critical care. Congress must act immediately to prioritize therapy cap repeal to avoid denials of crucial therapy services and disruption of patient care.

In October 2017, the House and Senate reached a bi-partisan policy agreement that would permanently repeal therapy caps, but failed to act before the recess to enact vital legislation. Under the current policy, Medicare beneficiaries cannot receive outpatient occupational therapy services, and, separately, physical therapy and speech language pathology services combined, if those services would exceed the "cap" amount, regardless of medical need.

Your Academy has long advocated for full repeal of the arbitrary therapy caps that harm beneficiaries most in need of these services. Congress must understand that these caps will inhibit Medicare beneficiaries' ability to get proper care for the appropriate duration of time, and limitations on this critical care reduces the patient's opportunity to maximize their function and to improve their quality of life.

Please take a moment to send a customizable email to your members of Congress today, urging that they immediately act to permanently repeal the therapy cap.

Template Letter

As a constituent, physiatrist, and member of the American Academy of Physical Medicine & Rehabilitation (AAPM&R), the national medical specialty organization representing more than 10,000 physicians who are specialists in physical medicine and rehabilitation (PM&R), I am writing to ask that you act now to repeal the Medicare outpatient therapy caps. My patients, especially those with significant disabling conditions, are facing the reality of not being able to receive needed rehabilitation therapy services. I urge you to stop the therapy caps from limiting the care I prescribe to my patients.

In 1997, Congress implemented caps on the total amount of rehabilitation services that Medicare would cover. These caps place arbitrary limitations on beneficiaries at the very time they need therapy most. Over the past two decades, Congress has acted multiple times to delay and reduce the impact of the caps; however, for the first time in over a decade, Congress's inaction has allowed the caps to go into effect, limiting my patients' ability to receive needed physical therapy, occupational therapy, and speech-language pathology services.

For some of my patients with significant rehabilitation needs, such as those recovering from stroke, brain injury, or spinal cord injuries, the implementation of the therapy caps means they are facing a premature end to their road to recovery. As a result, some of these patients will deal with significant setbacks impacting their overall outcomes.

Congress can stop the caps, and has already reached an informal bipartisan, bicameral agreement to end them. This important agreement will help my patients receive the care they need, at a time they need it most.  I am calling on you and your colleagues in Congress to act now to pass legislation to stop the therapy caps, to prevent further disruption to my patients' care.

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.