2020 MEDICARE CAP ON THERAPY SERVICES General Requirements:Patients receiving ANY type of home health services are ineligible for outpatient physical therapy.Have you received ANY outpatient physical therapy or speech therapy services since January 2020?* Yes No If yes indicate date(s):* Date Format: DD slash MM slash YYYY Have you received ANY home health services (nursing, therapy, etc…) in last six months?** Yes No If yes indicate date service ended:**If at any time during your course of physical therapy care, you agree to or begin receiving any home health services, you will be held financially responsible for the treatment incurred from Vital Physical Therapy, as Medicare does not allow you to receive both outpatient care and home health Services simultaneously.**2020 THERAPY CAP: The annual deductible for year 2020 is $198. Medicare has placed a $2080 cap on outpatient therapy services for the year 2020. This includes both physical therapy and speech therapy. If you have any questions or concerns regarding this limitation, please speak to our office manager/therapist. My signature below indicates that I have read and understand the above information regarding the Medicare Therapy Cap and have all my questions answered.Patient Name*DOB* Date Format: DD slash MM slash YYYY Patient Signature:*Date:* Date Format: DD slash MM slash YYYY
