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: