Medicare Payments, Therapy Caps Set Through 2012.
by Ingrida Lusis
Legislation passed in late February averts a 27.4% reduction in Medicare fee schedule rates and extends the Medicare therapy cap exceptions process, both through 2012.
The provisions were included in the Middle Class Tax Relief and Job Creation Act of 2012. The legislation extends the fee schedule that had been in place for the first two months of 2012.
The extension of the therapy cap exceptions process—which allows Medicare beneficiaries to receive speech-language and physical therapy services beyond an $1,880 limit—includes additional safeguards to ensure that only medically necessary services above the cap are permitted:
- The use of the National Provider Identification number (NPI) of the physician reviewing the need for treatment.
- The continued use of the “KX” modifier on claims above the cap.
- A required manual medical review when expenditures reach $3,700 (combined physical therapy and speech-language treatment) for services furnished on or after Oct. 1, 2012.
- Temporary application of the therapy caps to hospital outpatient departments for services provided from Oct. 1 through Dec. 31, 2012.
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