On Wednesday, President Obama signed the Middle Class Tax Relief and Job Creation Act of 2012 (HR 3630), extending the therapy cap exceptions process for the remainder of 2012. The law mandates consistent use of the KX modifier upon reaching the $1,880 therapy cap and puts in place several reforms to the therapy cap policy.
Starting October 1, claims that meet or exceed $3,700 in annual therapy expenditures will be subject to a manual medical review. The $3,700 threshold will be applied to the combined physical therapy/speech-language pathology cap; a separate $3,700 threshold will be applied to the occupational therapy cap. Also starting October 1, each request for payment must include the national provider identifier of the physician who currently periodically reviews the plan of care. Additionally, HR 3630 designates that the therapy cap along with the exceptions process should apply to the hospital outpatient setting no later than October 1. This provision, along with the full exceptions process, will expire at the end of 2012 unless Congress chooses to extend them into 2013.
An information bulletin, podcast, and FAQs thoroughly outline these new provisions and also address 2 key reports mandated by the law to review methods to improve the outpatient therapy benefit and examine the manual medical review process.