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March 27, 2018


Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More


Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More


OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More


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Medical Coding News Archives

Outpatient Therapy Cap Exception Extended

 
April 22, 2010:

As part of the Patient Protection and Affordable Care Act that President Obama signed into law on March 23, the exceptions process for outpatient therapy caps was extended for another year (see section 3103).

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.

Outpatient therapy service providers may continue to submit claims with modifier KX, when an exception is appropriate, for services furnished on or after January 1, 2010, through December 31, 2010.

Deborah C. Hall
Clinical/Technical Editor
Key Terms: Outpatient Therapy Cap, Modifier KX,

 

 
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