MLN Matters® Number: MM6660 Revised
Related Change Request (CR) #: 6660
Related CR Release Date: November 23, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R1860CP
Implementation Date: January 4, 2010

Note: This article was revised on November 24, 2009, to reflect a revised CR 6660 that the Centers for Medicare & Medicaid Services issued on November 23, 2009. As a result of the revised CR, the article was revised to include Regional Home Health Intermediaries as an additional contractor type involved with this issue. The CR release date, transmittal number, and Web address for accessing CR 6660 were also changed. Also, carriers were added as a contractor type involved as they were inadvertently not included in the original article. All other information remains the same.

Provider Types Affected
This article is for providers and suppliers submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), A/B Medicare Administrative Contractors (A/B MACs), and/or DME Medicare Administrative Contractors (DME MACs)) for physical therapy, speech-language pathology, and/or occupational therapy services provided to Medicare beneficiaries.

Provider Action Needed
This article is based on Change Request (CR) 6660 which describes the policy for outpatient therapy caps for 2010 and announces that therapy caps for 2010 will be $1860. Billing staff should be aware of these revised caps.

Background
The Balanced Budget Act 1997, P.L. 105-33, Section 4541(c) set annual caps for Part B Medicare patients. These limits change annually. The Deficit Reduction Act of 2005 (signed Feb. 8, 2006) directed that a process for exceptions to therapy caps for medically necessary services be implemented. Subsequently, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was enacted on July 15, 2008, and Section 141 extended the effective date of the exceptions process to the therapy caps to December 31, 2009. The exceptions process will continue unchanged for the time frame directed by Congress.

For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1860 for calendar year (CY) 2010. For occupational therapy services, the limit is $1860 for CY 2010. The limit is based on incurred expenses and includes applicable deductible and coinsurance.

CR 6660 revises the Medicare Claims Processing Manual (Pub. 100-04, Chapter 5 (Part B Outpatient Rehabilitation and CORF/OPT Services), Sections 10 (Part B Outpatient Rehabilitation and Comprehensive Outpatient Rehabilitation Facility (CORF) Services - General), and Section 20 (HCPCS Coding Requirement) to include the CY 2010 therapy caps, and this revision is included as an attachment to CR 6660.

Additional Information
You can find out more about Medicare therapy services and resources at www.cms.hhs.gov/therapyservices/ on the Centers for Medicare and Medicaid Services (CMS) website.

The official instruction, CR 6660, issued to your carrier, FI, RHHI, A/B MAC, and DME MAC regarding this change may be viewed at www.cms.hhs.gov/Transmittals/downloads/R1860CP.pdf on the CMS website.