Extension of Therapy Cap Exceptions Process
According to the Centers for Medicare & Medicaid Services (CMS), 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.
CMS Releases Transmittal 1678 on Outpatient Therapy Caps With Exceptions in CY 2009
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.