Tuesday, February 05, 2013 CMS Clarifies Therapy Cap Exceptions for Critical Access Hospital Patients In 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). However, 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 review process. APTA 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.