CMS Releases Transmittal 2457 Regarding Outpatient Therapy Cap

The Centers for Medicare & Medicaid Services (CMS), on April 27, 2012, released Transmittal 2457 (Change Request 7785).

This transmittal covers therapy cap manual review thresholds.  For calendar year 2012, there will be two therapy service thresholds of $3700 per year; one annual threshold each for

(1) occupational therapy services and

(2) physical therapy services and speech-language pathology services combined.

Services will accrue toward the thresholds beginning with dates of service on and after January 1, 2012 for services with and without the KX modifier.  Beginning with dates of service on or after October 1, 2012, contractors will apply the thresholds to claims exceeding it by suspending the claim for manual review.

Further, the National Provider Identifier (NPI) of the certifying provider identified for a therapy plan of care must be included on the therapy claim.

Also addressed in the transmittal is the temporary application of therapy caps to outpatient Part B therapy services furnished in outpatient hospitals other than Critical Access Hospitals on/after October 1, 2012 and on/before December 31, 2012.

To see the full transmittal, click here.

CMS Releases Transmittal 1678 on Outpatient Therapy Caps With Exceptions in CY 2009

February 17, 2009 · Posted in Industry News · Comment 

The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1678 on February 13, 2009.  This transmittal describes the policy for outpatient therapy cap exceptions for 2009.  It also updates the dollar amount of therapy caps.

The 2009 allowed dollar amount for outpatient therapy limits, except outpatient hospital services, has been updated to $1840 for physical therapy and speech-language pathology combined and $1840 for occupational therapy separately.

The newly revised material is effective on January 1, 2009 with an implementation date of April 6, 2009.