Therapy Cap Exception Process Has Expired

March 31, 2015
Rick Gawenda

On March 26, 2015, the United States House of Representatives passed H.R. 2, the Medicare Access and CHIP Reauthorization Act, by a vote of 392-37. This legislation permanently repeals the flawed sustainable growth rate (SGR) formula, thereby avoiding the scheduled 21.2% reduction that is to go into effect on April 1, 2015 and provides a 0.5% increase in payments under the Medicare Physician Fee Schedule beginning this year and continuing through 2019. This legislation also extends the therapy cap exception process for outpatient therapy services through December 31, 2017.

This legislation was then sent to the Senate; however, the Senate adjourned for their Easter recess on the morning of March 27, 2015 without taking a vote on this legislation. The Senate will reconvene on April 13, 2015 and is expected to act swiftly on this legislation.

So what does this mean for you and your Medicare beneficiaries right now? As of April 1, 2015,

The content here is for members only log in here or sign up.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. so my question is, do we hold our billing up until the Senate comes back into session and signs. Or does it not matter because they will go by the date of service? Will they retro whatever got the reduction? The powers that be in my office wants me to hold medicare billing up, not sure if necessary.

    1. If the Senate does pass legislation thereby giving providers a 0.5% increase instead of the 21.4% reduction and your claims had already been paid, they should automatically re-process your claims. The bigger issue is with the KX modifier. What you want to do regarding holding of the claims is up to you.