Friday, December 09, 2011 House Bill Includes SGR Fix, Extends Cap Exceptions Process Today, the House of Representatives released language of the health care provisions in the Middle Class Tax Relief and Job Creation Act. The bill updates the Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) for 2012 and 2013 by 1% -- negating a scheduled 27.4% reduction in payments to providers, including physical therapists who bill under the fee schedule. The bill also provides a 2-year extension of the therapy cap exceptions process with modifications. As currently written, the bill creates a 2-stage exceptions process. In this 2-stage process, physical therapists would submit claims using the KX modifier when the $1,880 cap is reached. At $3,700 a manual review would be required to ensure that the plan of care is medically necessary. APTA is reviewing this and other provisions of the bill, including the application of these provisions in the outpatient hospital setting and federal agency reporting on the new process. The House is expected to vote on the bill next week. Early next week the Senate is expected to release its version of the bill. Both chambers need to pass their respective bills and send them to conference for a final bill to be drafted and sent back to both the House and Senate for full votes. Thus, today's action by the House is just the beginning of what promises to be a long and uncertain week on Capitol Hill.