December 3, 2015

Therapy Cap Amounts for 2016

Therapy Cap Amounts for 2016

The Centers for Medicare and Medicaid Services (CMS) recently announced the therapy cap amounts for outpatient therapy services provided to Medicare beneficiaries. The cap will increase by $20 to $1,960 for combined physical therapy and speech language pathology and $1,960 for occupational therapy.

The therapy cap exception process, using the KX modifier, remains in effect through calendar year 2016 and calendar year 2017. Please be sure that proper documentation exists to support the exception.

The manual medical review process for claims over the $3,700 threshold also remains in effect.  Although the regulation does not require every claim over $3,700 be subject to manual medical review, any Medicare claim is potentially subject to medical review.

If you have any further questions about the therapy caps process or would like help reviewing your therapy documentation, please contact a member of our Health Care Team at 847-282-6300.

Information contained herein is accurate at the time of publication. We recommend that you consult with your Marcum advisor before implementing any action.

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