Skip to main content

The therapy cap limits for 2017 are $1,980 for physical therapy and speech-language pathology services combined. Under the automatic exceptions process, however, you can treat patients beyond the cap if you believe that continuing therapy is medically necessary. To do so, you must attach the KX modifier to the therapy procedure code and document your reasons for continuing treatment. You can use the automatic exceptions process to treat patients beyond the $1,980 cap until the patient reaches the $3,700 threshold. When services exceed $3,700, therapy claims may be subject to review.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the therapy cap exceptions process through December 31 of this year and modified the requirement for manual medical review for claims that exceed the $3,700 annual threshold for therapy services provided under Medicare Part B. MACRA eliminated the requirement for manual medical review of all claims exceeding the threshold, instead allowing for a targeted review process based on these criteria:

Log in or create a free account to keep reading.


Join APTA to get unlimited access to content.


You Might Also Like...

Column

Commercial Payers and the Post-Pandemic Landscape

Aug 1, 2020

Trends are clear. Provider planning is essential.

Column

Your Questions Answered

Dec 1, 2019

Use the information and resources here to get the details you need on regulatory compliance and related legal issues.

Column

Ownership Change And Medicare

Jul 1, 2019

Here are the basics on what to report and under what circumstances.