Therapy Cap Exceptions Process Extended
A delay in Medicare physician payment cuts wasn’t the only important feature of the Temporary Extension Act of 2010, enacted on March 2, 2010.
The Centers for Medicare and Medicaid Services (CMS) reported that the bill also extends the therapy cap exceptions process through March 31, 2010, retroactive to Jan. 1, 2010.
A release from CMS says, “Outpatient therapy service providers may now submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after Jan. 1, 2010 through March 31, 2010.”
CMS offered the following guidance to physicians and other therapy providers who may have handled the cap problem differently.
If you have been holding claims for services furnished on or after Jan. 1, 2010, for patients who exceeded the cap but qualified for an exception under previous law, you should submit those claims to Medicare effective immediately.
If you have submitted claims that were denied for services furnished on or after Jan. 1, 2010, for patients who exceeded the cap but whose services now qualify for an exception, you should contact your Medicare contractor to request that their claim be adjusted to add the KX modifier and ensure the appropriate exception applies.
If you have continued to submit claims with the KX modifier for services furnished on or after Jan. 1, 2010, even though the exceptions process had expired on Dec. 31, 2009, you do not need to take any action on the claims that were held. Medicare contractors held these claims and will now begin to release them for processing.
If you charged beneficiaries for services that exceeded caps, which are now payable under the exception process, you should refund the beneficiary’s cost, less the appropriate amount of deductible and co-insurance. Affected claims should be either submitted or, if already submitted, the provider should contact their contractor for an adjustment.
The therapy caps are determined on a calendar year basis, so all patients began a new cap on Jan. 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.
Last Updated: 3/3/2010