Overview

Extension of Therapy Cap Exceptions Process

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, which extends the exceptions process for outpatient therapy caps (see Section 3103).  Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2010, through December 31, 2010.  

The therapy caps are determined on a calendar year basis, so all patients began a new cap year on January 1, 2010.  For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860.  For occupational therapy services, the limit is $1,860.  Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.    

Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.

Overview

Medicare Part B provides coverage for many types of therapy services. This document serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services, coverage requirements, payment systems, and points of contact for further information.

The Medicare contractor who pays your claims is the best source of answers to specific Medicare questions. Medicare Contractors (Carriers/ Intermediaries/ A/B Medicare Administrative Contractors) interpret Medicare laws, develop local policies, and educate providers. To find local coverage policy and other general instructions, contact your Medicare Contractor using the Provider Call Center Toll-free Numbers Directory which includes phone numbers and website addresses (See Downloads section below).

If you are have difficulty communicating with your contractor, use the CMS Regional Offices' web page (See Related Links Inside CMS below) to identify the CMS Regional Office servicing your area of operations and utilize either the toll-free number or mailing address for assistance.

Downloads
Audiology Code List [PDF 33KB] Medicare Claims Processing Manual, Chapter 5, Sections 10, 20, 30, 40, 100 [PDF, 431KB] Medicare Benefit Policy Manual, Chapter 15, Sections 220 and 230 [PDF, 831KB] CR 4115 [PDF, 173KB] MM4115 [PDF, 306KB] CR 4226 [PDF, 375KB] MM4226 [PDF, 153KB] CR 5253 [PDF, 223KB] Provider Call Center Toll-Free Numbers Directory [ZIP, 27KB]
Related Links Inside CMS
2009 Annual Update to the Therapy Code List CMS Regional Offices National Correct Coding Initiative Edits
Related Links Outside CMS
American Physical Therapy Association (APTA) American Occupational Therapy Association (AOTA) American Speech-Language-Hearing Association (ASHA)

Page Last Modified: 06/10/2010 11:46:19 AM
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