MDS Alert

Published on Mon Apr 20, 2009 PDF

Keep your Part B therapy cap payments flowing smoothly. The outpatient therapy cap is $1,840 (for PT and speech therapy combined) and $1840 for OT for 2009. But your Medicare contractor's claims system won't reflect that until April. It will reject therapy claims that exceed the 2008 cap amount of $1,810 until then, CMS said in Transmittal No.1678. However, if your claims are valid and you have good documentation to back them up, you are still entitled to receive the full 2009 therapy cap amount.

The solution: If you get a rejected claim, just treat it as you would if you were submitting for a therapy cap exception. Just resubmit the claim with the KX modifier for payment, the Centers for Medicare & Medicaid Services instructed in the memo online at www.cms.hhs.gov/transmittals/downloads/R1678CP.pdf.

"Claims with KX modifiers shall circumvent the cap rejection in CWF," CMS instructs.