Therapists were left hanging over therapy cap exceptions at the end of 2009 when Congress recessed for the holidays. The only sure news was that the 2009 Medicare Physician Fee Schedule conversion factor would stay the same until Feb. 28, 2010, per the Department of Defense (DOD) Appropriations Act of 2010. The DOD legislation, however, did not include language to extend the therapy cap exceptions process beyond 2009, according to PT Bulletin Online. In addition, the House and Senate versions of health care reform legislation, which include provisions to extend the exceptions process, still remain unresolved, as of press time. Without therapy cap exceptions, each Medicare beneficiary will be subject to an annual cap of $1,860 for outpatient occupational therapy services and of $1,860 forphysical therapy and speech-language pathology services combined for 2010. Important:
Remember:
No exceptions process means you cannot use modifier KX on your claims for services over the caps. Make sure your billing software is adjusted, too. If your patient exhausts a cap and still needs therapy, he may pay out of pocket for the extra services, or you can refer him to an outpatient hospital facility, as this setting is exempt from the caps.Meanwhile:
Stay active with your congressional representatives regarding the Medicare conversion factor issue. After Feb. 28, 2010, the originally planned 21.29 percent cut to the conversion factor will take effect. The DOD legislation delays this cut through February in hopes that Congress can vote on a permanent solution to the fee schedule formula, the Bulletin reported.