a meeting with APTA yesterday, the Centers for Medicare and Medicaid Services
(CMS) clarified the impact of the therapy cap on patients who receive
outpatient therapy services in critical access hospitals (CAHs). CMS stated
that for 2013, when a patient receives outpatient therapy services from a
critical access hospital, the services will count toward dollars accrued toward
the therapy cap. For example, if a patient receives $2,000 of outpatient
therapy services in a CAH and upon discharge goes to a private practice to
continue therapy services, the private practice would need to obtain an
exception (in this case use the KX modifier).
CMS clarified that for 2013 the therapy cap does not apply to outpatient
therapy services provided within CAHs themselves. This means that if the
patient continued treatment in the critical access hospital, after exceeding
$1,900 in therapy services, there would be no need to seek an exception through
the automatic process. That is, the CAH would not need to submit the claim with
a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH,
the hospital would not need to obtain an exception through the manual medical
had been seeking clarification on this issue from CMS since the January 1
passage of the American Taxpayer Relief Act of 2012 (HR 8), which extended the
current 2-tier therapy cap exceptions process through 2013. The agency advised
APTA last month that it was working with its general counsel for interpretation
of the legislative language.
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