The Medicare Part B therapy cap was initiated by the Balance Budget Act of 1997 and has been extended by legislation several times throughout the years. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 extended the therapy cap exceptions process through 12/31/17 and included a targeted manual medical review for therapy services exceeding $3,700 for PT/ST (combined) and $3,700 for OT. Unfortunately, further legislation to extend the therapy cap did not occur prior to it expiring on 12/31/17. Over the years, grass roots efforts from PAC providers and therapy companies like PTS were coordinated urging Congress to permanently repeal the arbitrary therapy cap. Ongoing efforts were continued into 2018 after the exceptions process to the therapy cap expired.
What You Need To Know
Last week, as part of the bipartisan budget deal legislation, the therapy cap was permanently repealed and signed into law with a retroactive effective date of Jan 1st, 2018. After over 20 years, we will no longer have to advocate for continued legislation to extend the therapy caps exception process!
As part of this therapy cap repeal:
The KX modifier will continue to be required on claims over $2,010 for PT/ST and $2,010 for OT (for tracking purposes).
The targeted manual medical review threshold has been lowered from $3,700 to $3,000 for PT/ST services and a separate $3000 threshold for OT services.
While PTS never allowed the arbitrary therapy cap and threshold to impact the delivery of medically necessary services to our residents, we are very pleased that Congress and the White House has passed this legislation.
As your Rehabilitation Partner, Preferred Therapy Solutions continues to collaborate with your facility.
If you have any questions, please contact Maria Maggi, Vice President of Compliance: firstname.lastname@example.org