CHA News Article

Additional Information on Therapy Caps Available
Updated guidance posted on Palmetto GBA website

Effective Oct. 1, outpatient physical therapy, speech/language pathology and occupational therapy services provided in hospital outpatient departments will be subject to financial limitations, known as therapy caps. A therapy cap exception process allows providers to receive payment for medically necessary therapy services above the cap. Palmetto GBA, the Medicare administrative contractor for California, has posted updated information to its website, including guidance on claims submission, prior authorization requests and other issues. The updated information is available on the Palmetto GBA website at In addition, therapy services provided above a specified threshold are subject to manual medical review. The Centers for Medicare & Medicaid Services has issued information regarding the manual medical review process. Resources include the attached fact sheet and a frequently asked questions document that explain the Part B outpatient therapy caps and exceptions.