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Medicare Compliance & Reimbursement

IN OTHER NEWS ...• The outpatient therapy cap is $1,840

Published on Mon Jan 26, 2009

• The outpatient therapy cap is $1,840 for 2009, but the 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 says in Feb. 13 CR 6321 (Transmittal No. 1678). Home health agencies can just resubmit the claim with the KX modifier for payment, CMS instructs 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 says. The therapy caps apply only to outpatient Part B therapy, not therapy furnished under a home health plan of care.
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