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 Gets a Fresh New Look on its Website

December 7, 2011 · Posted in Industry News · Comment 

The Centers for Medicare & Medicaid Services (CMS) has expanded and enhanced its online presence by debuting a new look and feel for, and launching a brand-new site for the Medicaid program,  CMS says these changes come in response to what users have said they wanted to be able to do on the site. 

Here’s what you’ll find on the new CMS and Medicaid sites:

  • A significantly improved search engine that gets you to the information you’re looking for, fast.
  • More in-depth information about what CMS is doing to implement the Affordable Care Act and other new initiatives, and details about how you can apply for new programs.
  • Up-to-date, real-time updates that reflect important developments and initiatives happening with CMS programs.
  • Medicaid program information that’s readily available, easy to find, and easy to use.
  • Easy-to-access links to, which will continue to be the primary site for consumer information.

While CMS has moved content around to make it easier to find, you shouldn’t lose access to any of the current Medicare and Medicaid information you rely on now. They’re launching an archive version of each of the websites so that historic information can remain online without adding clutter to their primary sites.

Check it out at and

CMS Announces Series of Nationwide RAC 101 Calls

April 7, 2010 · Posted in RAC · Comment 

The Centers for Medicare and Medicaid Services (CMS) has announced a series of “Nationwide RAC 101 Calls.” The calls, open to the public healthcare community, are scheduled for late April and early May as follows:

  • April 28, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call, 1-877-251-0301
  • May 4, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers, 1-877-251-0301
  • May 5, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for DMEPOS, 1-877-251-0301
  • May 12, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for Physicians, 1-877-251-0301

For updated call schedule information, go to

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.