Current Extension of Exceptions Process for Medicare Therapy Caps [01-09-12]

Filed under: Industry Updates — Editor @ 11:32 am

Section 304 of the TPTCCA extends the exceptions process for outpatient therapy caps. Outpatient therapy service providers may continue to submit claims with HCPCS modifier KX, when an exception is appropriate, for services furnished on or after January 1, 2012, through February 29, 2012.

The therapy caps are determined on a calendar year basis, so all patients begin a new cap year on January 1, 2012.

For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,880.

For occupational therapy services, the limit is $1,880.

Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached, and also apply for services above the cap where HCPCS modifier KX is used.

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