Medicare Publishes Guidance on Therapy Cap Exceptions Process
The Centers for Medicare and Medicaid Services (CMS) released on January 16, 2008, policy guidance to assist therapists navigate the therapy cap exceptions process.
OT services will be limited to $1,810 per beneficiary during 2008. However, AOTA advocated successfully for a therapy cap exceptions process under the Medicare, Medicaid, and SCHIP Extension Act. The exceptions process will apply for 6 months from January 1, 2008 through June 30, 2008, and will require that providers attest to the medical necessity of additional services beyond the cap by appending a KX modifier on claims for services and to document the need for additional services in the patient’s medical record.
The CMS transmittal provides practitioners with a list of ICD-9 codes that are likely to qualify for exception to the therapy cap based upon clinical condition or complexity. AOTA is currently analyzing the CMS transmittal and additional information will be forthcoming, but the exceptions process for 2008 does not appear to differ substantively from the exceptions process in place during 2007.
Medicare Transmittal 1414
Medlearn Matters article (MM5871)