Railroad Medicare
Expiration of Therapy Cap Exceptions Process
The Centers for Medicare & Medicaid Services (CMS) continues to work with Congress on significant legislation which affects the Medicare program. We believe this and other provisions may be extended as part of this legislation. We encourage you to monitor Congressional activity and stay apprised of the status of potential legislation. In the meantime, if such legislation is enacted, CMS will notify Medicare fee-for-service claims processing contractors to again process claims for those affected services. Providers may choose to hold their claims in the event legislation about this issue is enacted. However, current law mandates the following change:
The exceptions to outpatient therapy caps expire on December 31, 2009. Outpatient therapy service providers should not submit claims with the KX HCPCS modifier for services furnished on or after January 1, 2010. The therapy caps are determined on a calendar year basis, so all patients will begin a new cap year 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.
