RSS FeedCMS Medicare part B Therapy Caps in effect as of January 1, 2010
The Medicare part B therapy caps have not been extended as of this date. All residents on Medicare part B therapy should be reviewed for use of their $1860.00 limits as of January 1, 2010.
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. One provision of this legislation extends the effective date of the exceptions process to the therapy caps to December 31, 2009. Outpatient therapy service providers may now resume submitting claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008.
For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1860 for calendar year 2009. For occupational therapy services, the limit is $1860. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. Services that meet the exceptions criteria and report the KX modifier will be paid beyond this limit, whenever the exceptions policy is in effect.
These KX modifiers and the exceptions have been lifted as of January 1, 2010. This means that all residents that are served under Medicare B for PT, OT or SLP services can only use the $1860.00 combined for PT and SLP and $1860.00 for OT. Once this amount is provided Medicare will no longer cover the services financially.
Legislation is in the works to continue the exception or completely remove the caps, but this is not pending for at least a week or two. PANAC will keep you informed as to what the outcome is on the legislation.