Therapy Services

Extension of Therapy Cap Exceptions Process

In December 15, 2010, President Obama signed into law The Medicare and Medicaid Extenders Act of 2010, which extends the exceptions process for outpatient therapy caps (see Section 104). Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2011, through December 31, 2011. Follow manual policies that apply when exceptions are in effect.

The therapy caps are determined on a calendar year basis, so all patients begin a new cap year on January 1, 2011. For physical therapy and speech language pathology services combined, the limit on incurred expenses was $1,860 in 2010 and is $1,870 in 2011. For occupational therapy services, the limit was $1,860 in 2010 and is $1,870 in 2011. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.

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.