Last Modified: 10/4/2018 Location: FL, PR, USVI Business: Part A, Part B
Q: What therapy cap and therapy thresholds information appear in SPOT and where can I find it?
A: SPOT displays information on therapy caps and thresholds in the in the Check Eligibility and Benefits section under the “Deductibles/Caps” tab. The Centers for Medicare & Medicaid Services’ (CMS) HIPAA Eligibility Transaction System (HETS) provides all eligibility data accessed through the SPOT.
The images below represent a fictional example of a Medicare beneficiary. First Coast offers up-to-date information on 2018 Medicare deductibles.
Two subsections, Occupational Therapy Cap and Physical and Speech Therapy Cap, display the “used amount” instead of “remaining amount.”
The “used amount” listed under each category will continue to increase even after the Cap has been reached to allow providers to determine when therapy usage has exceeded the cap and has reached therapy thresholds in accordance with Medicare policy.
For more information about therapy caps and billing, please review our Therapy and rehabilitation services FAQs.
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