Therapy Caps Exceptions Process Reinstated

Dear Clients and Friends:

President Obama has signed into law, HR 4691, The Temporary Extenders Act of 2010.  This bill retroactively reinstates the therapy cap exception process from January 1, 2010 through March 31, 2010.  It also provides a temporary 30 day stop of the 21.2 percent cut in the physician (including therapy) fee schedules through March 31, 2010.  The Senate continues its work on another bill, which includes a longer term extension of each of these provisions.

A CMS Provider Communication provides the following guidance regarding how to handle therapy claims:

“Some therapy providers have been holding claims for services furnished on or after January 1, 2010, for patients who exceeded the cap but qualified for an exception under previous law.  These providers may submit those claims to Medicare effective immediately.   Therapy providers, who submitted claims which were denied, for services furnished on or after January 1, 2010, for patients who exceeded the cap but whose services now qualify for an exception, should contact their Medicare contractor to request that their claim be adjusted to add the KX modifier and ensure the appropriate exception applies.

A small number of therapy providers continued to submit claims with the KX modifier for services furnished on or after January 1, 2010, even though the exceptions process had expired on December 31, 2009. Medicare contractors held these claims and will now begin to release them for processing. These providers do not need to take any action on the claims that were held.

Providers who charged beneficiaries for services that exceeded caps, which are now payable under the exception process, should refund the beneficiary’s cost, less the appropriate amount of deductible and co-insurance. Affected claims should be either submitted or, if already submitted, the provider should contact their contractor for an adjustment.”

We will keep you posted as to continuing developments.