AOTA Meets with CMS about the Medicare Part B Outpatient Therapy Cap and Exceptions Process for 2012
On March 23, 2012, AOTA—in coalition with other provider associations—met with leadership from the Centers for Medicare & Medicaid Services (CMS) to discuss the Medicare Part B outpatient therapy cap and exceptions process in the wake of recent legislation. The calendar year (CY) 2012 statutory cap for occupational therapy is $1,880, and the combined cap for physical therapy and speech-language pathology is also $1,880. This is an annual per beneficiary cap amount tallied beginning January 1 of each year. The Middle Class Tax Relief and Job Creation Act of 2012 (H.R. 3630) extended the exceptions process through December 31, 2012; expanded the therapy cap to cover hospital outpatient departments (HOPDs) as of October 1, 2012; reiterated mandatory use of the KX modifier for claims that go above the cap; called for a manual medical review of claims over $3,700; and set in place rules for collection of functional data beginning in 2013.
AOTA questioned CMS about the application of the cap to HOPDs and the timing of therapy cap dollar accrual, as well as about the details of manual medical review.
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