Therapy Cap Exception Process

March 10, 2014
Rick Gawenda

If Congress does not pass additional legislation either eliminating the therapy cap or extending the exception process prior to April 1, 2014, Medicare beneficiaries will not have coverage for outpatient therapy services once they exceed $1920 PT and SLP combined or a separate $1920 for occupational therapy. If no legislation is passed and no exception process is in place, therapy provided above the $1920 would be considered

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  1. Given this information,would you suggest we avoid the KX modifier until the decision on April 1 or go ahead and do tx with an ABN. My thoughts are that we could hold off on the few patients we have that are approaching the cap.

    1. The therapy cap exception process and use of the KX modifier is in effect for dates of service up to and including March 31, 2014.