2018 Therapy Cap Questions & Answers
With the 2018 therapy cap now beginning its 5th week, I am still receiving many questions concerning the therapy cap. In this article, I will answer the following questions:
- What is the 2018 therapy cap dollar threshold?
- How is the amount that is applied to the annual therapy cap dollar threshold calculated?
- How does the annual Part B deductible impact the annual therapy cap?
- What is the current status of the therapy cap exception process (ie. use of KX modifier)?
- What is the current status of the $3700 manual medical review threshold?
- What settings does the therapy cap apply to?
- What settings does the therapy cap not apply to?
- Does the therapy provided in an outpatient hospital count towards the annual therapy cap dollar threshold?
- Does the therapy cap apply to critical access hospitals?
- Are critical access hospitals exempt from the therapy cap?
- If a Medicare beneficiary exceeds the therapy cap and no exception process is in place, must I issue an ABN?
- Does the therapy cap apply to Medicare Advantage plans?
1. What is the 2018 therapy cap dollar threshold?