Therapy Management & Consulting Services Blog

Important Message from NASL: Therapy Cap Bill Text Released

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The following are the major points of the Therapy Cap exceptions process legislative language included in the Payroll Tax Cut Final Agreement  

  • Extension of the exceptions process through December 31, 2012.
  • When an exception is requested, the claim shall contain an appropriate modifier (such as the KX modifier) indicating services are medically necessary, and justified by appropriate documentation in the medical record.
  • All outpatient therapy services that exceed the $3,700 threshold shall be subject to a manual medical review process.
  • Temporary application of Therapy Caps to the hospital outpatient settings.
  • Requirement for inclusion on the claim of the NPI of physicians who review the therapy plan.
  • Requires a MedPAC report on "improved Medicare therapy benefits" by June 15, 2013.
  • HHS to collect additional claims based data beginning January 1, 2013.

Shortly, we will form a small workgroup to discuss how the manual medical review process was handled in the past, in relation to this new language.

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**Info taken from NASL to provide important information to our Customers and Associates.**