Medicare Therapy Cap

In 1997, Congress passed the Balanced Budget Act, which created the sustainable growth rate reform (SGR) formula and the Medicare therapy cap. These policies were enacted as cost saving measures. Since that time, Congress has continually acted to address the flawed SGR formula and to prevent a hard cap on outpatient therapy services with short-term fixes. This year, Congress is looking to permanently reform the sustainable growth rate formula so these annual fixes are no longer necessary.

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General Information

Take Action

  • Medicare Therapy Cap Advocacy: Stop the Cap!

    Learn more about how you and your patients can make a difference in efforts to stop the therapy cap.

  • Manual Medical Review Complaint Form

    If you are experiencing issues with the Medicare therapy cap exceptions process for 2012 or other issues related to the therapy cap and you have been unable to resolve your issues by contacting your Medicare Administrative Contractor (MAC), you may complete this complaint form. APTA staff will contact you within two business days using the information in the form to help you resolve your issue.

Centers for Medicare and Medicaid Services (CMS)

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