| The Therapy Cap Exception Process Extended Under the "Temporary Extension Act of 2010" |
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The Temporary Extension Act of 2010, enacted on March 2, 2010, extends the therapy cap exceptions process through March 31, 2010, retroactive to January 1, 2010. Outpatient therapy service providers may now submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2010 through March 31, 2010. The therapy caps are determined on a calendar year basis, so all patients began a new cap on January 1, 2010. For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860. For occupational therapy services, the limit is $1,860. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. 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. -------------------------------------------------------------------------------- --------------------------------- Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you received this message as part of the All FFS Providers listserv, you are currently subscribed to one of eighteen Medicare Fee-For-Service (FFS) provider listservs. If you would like to be removed from all NIH listservs, please go to (https://list.nih.gov/LISTSERV_WEB/signoff.htm ) to unsubscribe. If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/show_list_archives ) to unsubscribe or to leave the appropriate listserv. If you know someone who would like to subscribe to a FFS provider listserv, go to (http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.p df ) . Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.hhs.gov/ContactCMS). Thank you. |