The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. One provision of this legislation extends the effective date of the exceptions process to the therapy caps to December 31, 2009. Outpatient therapy service providers may now resume submitting claims with the HCPCS modifier KX for therapy services that exceed the cap furnished on or after July 1, 2008.
Limit on Incurred Expenses
- For calendar year 2008, physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,810. For occupational therapy services, the limit is $1,810
- For 2009, the annual limit on the allowed amount for outpatient physical therapy and speech-language pathology combined is $1,840; and the separate limit for occupational therapy is $1,840
- For 2010, the annual limit on the allowed amount for outpatient physical therapy and speech-language pathology combined is $1,860; and the separate limit for occupational therapy is $1,860
Deductible and coinsurance amounts that are applied to therapy services count toward the amount accrued before a cap is reached. Services that meet the exceptions criteria that are submitted with HCPCS modifier KX will be paid beyond this limit.