Extension of Therapy Cap Exceptions

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008.  One provision of this legislation extends the effective date of the exceptions process to the therapy caps to December 31, 2009.  Outpatient therapy service providers may now resume submitting claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008.  

For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1840 for calendar year 2009.  For occupational therapy services, the limit is $1840.  Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.   Services that meet the exceptions criteria and report the KX modifier will be paid beyond this limit, whenever the exceptions policy is in effect.

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
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: 10/14/2009 3:22:31 PM
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