{"id":199,"date":"2021-07-08T05:22:20","date_gmt":"2021-07-08T05:22:20","guid":{"rendered":"https:\/\/atlanticrcm.com\/blog\/?p=199"},"modified":"2021-07-08T05:22:20","modified_gmt":"2021-07-08T05:22:20","slug":"the-physical-therapists-guide-to-therapy-cap","status":"publish","type":"post","link":"https:\/\/atlanticrcm.com\/blog\/the-physical-therapists-guide-to-therapy-cap\/","title":{"rendered":"The Physical Therapist’s Guide to Therapy Cap"},"content":{"rendered":"

The therapy cap was introduced as part of the Balanced Budget Act (BBA) of 1997. The hard cap is now replaced by the soft cap (or the annual threshold). The threshold for the year 2021 is $2110 for PT(Physiotherapy) and SLP (Speech-Language Pathology) services combined, and $2110 for OT (Occupational Therapy) services. This threshold value is set annually by the Medicare Economic Index (MEI). All the diagnoses that the patient undergoes within the benefit period correspond to the same threshold.<\/p>\n

The annual threshold does not intend to prevent Medicare patients from obtaining medically necessary care. It applies to all Medicare Part B outpatient therapy services provided at different facility types. They include private practices<\/a>, physician offices, skilled nursing facilities, outpatient rehabilitation facilities (ORF), comprehensive outpatient rehabilitation facilities (CORF), home health agencies, critical access hospitals<\/a>, hospital outpatient departments (HOPD), and outpatient hospitals.<\/p>\n

\"The

The Physical Therapist Guide to Therapy Cap<\/p><\/div>\n

The recent changes in the therapy cap help the physical therapists<\/a> to continue providing medical services to their patients (if necessary) even if the cost exceeds the annual threshold. This is possible due to the automatic exceptions process.<\/p>\n

Automatic exception process: KX modifiers are the therapist\u2019s attestation and confirmation justifying continued treatment as per medical records. No additional documentation is required. In cases where the therapy history is not available with the patient, providers can request it from CMS. Automatic exceptions are applicable for all claims beyond the threshold amount up to a maximum of $3,000. The KX modifier should be affixed considering the following factors:<\/p>\n