CMS Issues Instructions for Reprocessing of Therapy Claims

The Centers for Medicare and Medicaid Services has issued guidance to the Medicare Administrative Contractors (MACs) how to reprocess outpatient therapy claims that were previously denied before the passage of the Bipartisan Budget Act of 2018 or were denied after the passage of the Bipartisan Budget Act of 2018 even though the KX modifier was appended to services that had been delivered above $2010 in calendar year 2018. In addition, some MACs will have to reprocess therapy claims due to changes in the Work Geographic Price Cost Index (GPCI) floor. This means that some providers in some states will see additional payment for visits that were already paid.

The instructions are as follows: