The Centers for Medicare and Medicaid Services (CMS) has posted a list on its website assigning providers to 1 of 3 phases for manual medical review when outpatient therapy services exceed $3,700. The list identifies phase I and phase II providers by their National Provider Identifier; those who do not appear on the list are included in phase III. The phases delineate the time frames during which the providers would be required to obtain advanced approval from their Medicare Administrative Contractor (MAC) in order to receive coverage for outpatient therapy services beyond $3,700.
Additional information regarding the therapy cap and the manual medical review process is available on APTA's website. CMS also provides a fact sheet and question-and-answer document regarding the process. MACs are expected to issue additional information about the process in the near future.
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