Outpatient Rehabilitation Therapy Cap

1. Outpatient Rehab Therapy Cap www.wbcindia.com

2. Therapy Cap ● Therapy caps are Medicare law which limits how much it pays for your medically necessary outpatient therapy services in one calendar year. ● The therapy cap is exception process for use of the KX modifier and the manual medical review (MMR) process.

3. Therapy Cap Updates ● Hospital OP Clinics are exempt from the therapy cap, they do NOT have to track against the limit of $2,010. ● Non-hospital-based outpatient therapy settings are NOT exempt from the therapy cap. ● All Medicare beneficiaries that exceed the $2,010 amount in these settings will be statutorily responsible to pay the provider for any therapy services that exceed the therapy cap.

4. Latest Update from CMS ● CMS is committed to implementing the Medicare program in accordance with applicable laws and regulations, including timely claims processing. ● CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold”.

5. What to do now? ● Try to minimize the touches you need to do for your Medicare Authorizations during this uncertainty period. ● Assure that if the therapy exception process is extended, the tracking of the therapy cap will not be interrupted. ● Continue to conduct business as if the therapy cap with KX modifier is in place.

6. Thank You www.wbcindia.com