Exceptions to Outpatient Therapy Caps Restricted on or After July 1

June 11, 2008

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CMS allowed exceptions to outpatient therapy caps from January 1, 2008 to June 30, 2008 for medically necessary services that were appropriately billed with KX modifiers. On or after July 1, 2008, the exceptions to therapy caps are restricted to those medically necessary services billed by the outpatient departments of hospitals; and use of the KX modifier will no longer be effective.

If, on July 1, 2008, a therapy cap has already been reached, a beneficiary who is not a resident in the Medicare-certified part of a skilled nursing facility will be able to obtain medically necessary services that exceed the cap only when the services are billed by the outpatient department of a hospital.

Physicians should make sure that their billing staff is aware that outpatient therapy caps apply to all services in calendar year 2008, with exceptions for medically necessary services in all settings on or prior to June 30, 2008, and with exceptions limited to the outpatient hospital setting after June 30, 2008.

Read a MedLearn Matters article on this latest Therapy Caps news