The Medicare outpatient therapy caps for 2013 have been set at $1,900 for physical and speech therapy combined as well as $1,900 for occupational therapy. As in years past, patients who exceed their yearly therapy benefit can continue to receive care beyond the cap provided the documentation supports the need for skilled therapy services and the claims include a KX modifier on each line item. Exceptions to the therapy cap are allowed for reasonable and necessary therapy services. In addition to the therapy caps, the Middle Class Tax Relief and Job Creation Act of 2012 established a threshold in which services per beneficiary above $3,700 for PT and SLP services combined and/or $3,700 for OT services are subject to manual medical review. The American Taxpayer Relief Act passed earlier this year extended the manual medical review requirements through 12/31/13 but with some notable changes to the process.
The Medicare outpatient therapy caps for 2013
04 Tuesday Jun 2013
Posted Uncategorized
in